P-1599. First Report of Chloroquine Resistance in Field Isolates from Karachi Pakistan Using pfcrt and pfmdr Markers Associated with Drug Resistance
Session: Poster Session: Malaria and Babesia
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: The rapid spread of drug resistant malaria and the development of artemisinin compounds have radically changed the treatment options for malaria in Pakistan. This region has empirical treatment failure of P.falciparum to chloroquine (CQ) making this readily available option defunct. This study was done to asses the prevalence of chloroquine resistance in our region using molecular tools. Method: A total of 242 patients infected with P.falciparum presenting at Aga Khan University clinical laboratories were included in our study. The prevalence of pfcrt K76T and pfmdr1 N86Y genes were genotyped by multiplex PCR/RFLP method in P.falciparum isolates from Sindh province, Pakistan during 2005-2008. Results: Single nucleotide polymorphisms (SNPs) in pfcrt and pfmdr1 genes associated with resistance to CQ were observed in almost 92% (223/242) of the P.falciparum isolates which carried the 76T mutation and markedly few isolates had 76K polymorphism. In addition 57% of isolates had 86Y mutation at the pfmdr gene that is associated with, although not essential, for CQ resistance. Conclusion:We confirm the existence of Chloroquine drug resistance in Pakistan using modern molecular tools. The level of resistance suggests that chloroquine has no role in P falciparum infections. Therefore we expect high levels of treatment failures with CQ and suggest removal from the current treatment strategy. This data may be used in helping to formulate a rationale drug policy.
Afia Zafar, MBBS, FRCPath1, Andreas Martensson, MD2, Johan Ursing, MD2, Mohammad BEG, MBBS, PhD3, Najia Ghanchi, MSc4 and  A. Zafar, None., (1)Aga Khan University, Karachi, Pakistan, (2)Karolinska Institute, (3)Aga Khan University, KarachiI, Pakistan, (4)Aga Khan University

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