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Background  Non-synonymous mutations in  dhfr  and  dhps  genes in  Plasmodium vivax  are associated with sulfadoxine–pyrimethamine (SP) resistance. The present study aimed to assess the prevalence of point mutations in  P. vivax dhfr  ( pvdhfr)  and  P. vivax dhps  ( pvdhps ) genes in three countries: Lao PDR, India and Colombia.    Methods  Samples from 203 microscopically diagnosed vivax malaria were collected from the three countries. Five codons at positions 13, 57, 58, 61, and 117 of  pvdhfr  and two codons at positions 383 and 553 of  pvdhps  were examined by polymerase chain reaction-restriction fragment length polymorphism methodology.    Results  The largest number of 58R/117 N double mutations in  pvdhfr  was observed in Colombia (94.3 %), while the corresponding wild-type amino acids were found at high frequencies in Lao PDR during 2001–2004 (57.8 %). Size polymorphism analysis of the tandem repeats within  pvdhfr  revealed that 74.3 % of all the isolates carried the type B variant. Eighty-nine per cent of all the isolates examined carried wild-type  pvdhps  A383 and A553.    Conclusions  Although SP is not generally used to treat  P. vivax  infections, mutations in  dhfr  and  dhps  that confer antifolate resistance in  P. vivax  are common. The data strongly suggest that, when used primarily to treat falciparum malaria, SP can exert a substantial selective pressure on  P. vivax  populations, and this can lead to point mutations in  dhfr  and  dhps . Accurate data on the global geographic distribution of  dhfr  and  dhps  genotypes should help to inform anti-malarial drug-use policies.

Geographic distribution of amino acid mutations in DHFR and DHPS in Plasmodium vivax isolates from Lao PDR, India and Colombia