Genetic markers of resistance to @entity4765 and @entity13135 in @entity3964 parasites compared with the resistance patterns in isolates of XXXX from the same @entity1 in Guinea-Bissau.

@entity1 @entity1484 @entity15527 @entity11682 @entity526 @entity12838 @entity311 @entity16945 @entity13135 @entity3964 @entity207 @entity52882 @entity503 @entity4765 @entity166 @entity206
The antifolate drugs @entity16945 and @entity4765 are used for treatment of @entity503 -resistant @entity3964 in Africa. Resistance to @entity4765 has been associated with point mutations in the @entity12838 -gene and resistance to @entity16945 with mutations in the @entity52882 -gene. There is concern that the use of the antifolates @entity206 and @entity207 for treatment of other @entity166 will result in the selection of @entity311 parasites with mutations in these genes. In Guinea-Bissau, where @entity11682 and @entity206 -containing drugs have been used extensively, we decided to assess the prevalence of mutations in the @entity12838 -and @entity52882 -gene in @entity3964 isolated from @entity1 suffering from @entity15527 and to assess the resistance patterns to @entity206 / @entity207 in @entity526 isolated from the same @entity1 . A thick film and a blood sample for polymerase chain reaction (PCR) were obtained from 100 @entity1 attending the Bandim Health Centre in Bissau with symptoms compatible with @entity311 . Furthermore, a stool sample was collected from the same @entity1 and cultured for @entity526 . Of the cultured @entity526 , 67% were resistant both to @entity13135 and @entity206 , 4% to @entity13135 alone, 3% to @entity206 alone while 26% were fully sensitive to both drugs. PCR was successfully performed in 97 blood samples. Of these, 41% had triple mutations at the @entity12838 -gene (at codons 51, 59 and 108), and 15% had triple mutations plus mutation at codon 437 in the @entity52882 -gene. Only 45% harboured the wild-type @entity12838 -gene. Thus both bacterial resistance and mutations in the parasitic genes were common, but not linked in the individual @entity1 . As @entity1484 has only been used as a second line treatment for @entity503 resistant @entity311 in Guinea-Bissau for a few years, it is worrying to find a high prevalence of mutations in the parasitic genes coding for resistance to these drugs. Therefore, restricting the use of @entity1484 for the treatment of @entity503 resistant @entity311 might not be sufficient to prevent the development of resistance in the parasites as long as antifolate drugs are used extensively.
