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Background  Little information is available on resistance to anti-malarial drugs in the Solomon Islands (SI). The analysis of single nucleotide polymorphisms (SNPs) in drug resistance associated parasite genes is a potential alternative to classical time- and resource-consuming  in vivo  studies to monitor drug resistance. Mutations in  pfmdr1  and  pfcrt  were shown to indicate chloroquine (CQ) resistance, mutations in  pfdhfr  and  pfdhps  indicate sulphadoxine-pyrimethamine (SP) resistance, and mutations in  pfATPase6  indicate resistance to artemisinin derivatives.    Methods  The relationship between the rate of treatment failure among 25 symptomatic  Plasmodium falciparum -infected patients presenting at the clinic and the pattern of resistance-associated SNPs in  P. falciparum  infecting 76 asymptomatic individuals from the surrounding population was investigated. The study was conducted in the SI in 2004. Patients presenting at a local clinic with microscopically confirmed  P. falciparum  malaria were recruited and treated with CQ+SP. Rates of treatment failure were estimated during a 28-day follow-up period. In parallel, a DNA microarray technology was used to analyse mutations associated with CQ, SP, and artemisinin derivative resistance among samples from the asymptomatic community. Mutation and haplotype frequencies were determined, as well as the multiplicity of infection.    Results  The  in vivo  study showed an efficacy of 88% for CQ+SP to treat  P. falciparum  infections. DNA microarray analyses indicated a low diversity in the parasite population with one major haplotype present in 98.7% of the cases. It was composed of fixed mutations at position 86 in  pfmdr1 , positions 72, 75, 76, 220, 326 and 356 in  pfcrt , and positions 59 and 108 in  pfdhfr . No mutation was observed in  pfdhps  or in  pfATPase6 . The mean multiplicity of infection was 1.39.    Conclusion  This work provides the first insight into drug resistance markers of  P. falciparum  in the SI. The obtained results indicated the presence of a very homogenous  P. falciparum  population circulating in the community. Although CQ+SP could still clear most infections, seven fixed mutations associated with CQ resistance and two fixed mutations related to SP resistance were observed. Whether the absence of mutations in  pfATPase6  indicates the efficacy of artemisinin derivatives remains to be proven.

Monitoring of malaria parasite resistance to chloroquine and sulphadoxine-pyrimethamine in the Solomon Islands by DNA microarray technology