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Drug-resistant  Plasmodium vivax  malaria impedes efforts to control, eliminate, and ultimately eradicate malaria in Southeast Asia.  P. vivax  resistance to antifolate drugs derives from point mutations in specific parasite genes, including the dihydropteroate synthase ( pvdhps ), dihydrofolate reductase ( pvdhfr ), and GTP cyclohydrolase I ( pvgch1 ) genes. This study aims to investigate the prevalence and spread of drug resistance markers in  P. vivax  populating the China-Myanmar border. Blood samples were collected from symptomatic patients with acute  P. vivax  infection. Samples with single-clone  P. vivax  infections were sequenced for  pvdhps  and  pvdhfr  genes   and genotyped for 6 flanking microsatellite markers. Copy number variation in the  pvgch1  gene was also examined. Polymorphisms were observed in six different codons of the  pvdhps  gene (382, 383, 512, 549, 553, and 571) and six different codons of the  pvdhfr  gene (13, 57, 58, 61, 99, 117) in two study sites. The quadruple mutant haplotypes 57I/L/58R/61M/117T of  pvdhfr  gene were the most common (comprising 76% of cases in Myitsone and 43.7% of case in Laiza). The double mutant haplotype 383G/553G of  pvdhps  gene was also prevalent at each site (40.8% and 31%). Microsatellites flanking the  pvdhfr  gene differentiated clinical samples from wild type and quadruple mutant genotypes ( F   ST = 0.259-0.3036), as would be expected for a locus undergoing positive selection. The lack of copy number variation of  pvgch1  suggests that SP-resistant  P. vivax  may harbor alternative mechanisms to secure sufficient folate.

Polymorphism of Antifolate Drug Resistance in Plasmodium vivax From Local Residents and Migrant Workers Returned From the China-Myanmar Border