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Background  Anti-malarial drug resistance is a severe challenge for eventual control and global elimination of malaria. Resistance to sulfadoxine-pyrimethamine (SP) increases as mutations accumulate in the  Pfdhfr  and  Pfdhps  genes. This study aimed to assess the polymorphisms and prevalence of mutation in these genes in the  Plasmodium falciparum  infecting migrant workers returning to Wuhan, China.    Methods  Blood samples were collected for 9 years (2011–2019). Parasite genomic DNA was extracted from blood spots on filter paper. The mutations were evaluated by nested PCR and sequencing. The single-nucleotide polymorphisms (SNPs) and haplotypes of the  Pfdhfr  and  Pfdhps  genes were analysed.    Results   Pfdhfr  codon 108 showed a 94.7% mutation rate, while for  Pfdhps , the rate for codon 437 was 79.0%. In total, five unique haplotypes at the  Pfdhfr  locus and 11 haplotypes at the  Pfdhps  locus were found while the  Pfdhfr - Pfdhps  combined loci revealed 28 unique haplotypes. A triple mutant ( IRN I) of  Pfdhfr  was the most prevalent haplotype (84.4%). For  Pfdhps , a single mutant (S G KAA) and a double mutant (S GE AA) were detected at frequencies of 37.8 and 22.3%, respectively. Among the combined haplotypes, a quadruple mutant  (IRN I-S G KAA) was the most common, with a 30.0% frequency, followed by a quintuplet mutant ( IRN I-S GE AA) with a frequency of 20.4%.    Conclusion  The high prevalence and saturation of  Pfdhfr  haplotypes and the medium prevalence of  Pfdhps  haplotypes demonstrated in the present data will provide support for predicting the status and progression of antifolate resistance in malaria-endemic regions and imported malaria in nonendemic areas. Additional interventions to evaluate and prevent SP resistance should be continuously considered.

malaria journal

Molecular surveillance of anti-malarial resistance Pfdhfr and Pfdhps polymorphisms in African and Southeast Asia Plasmodium falciparum imported parasites to Wuhan, China