Despite being preventable and curable, over 200 million people worldwide are infected with malaria. Sub-Saharan Africa carries a disproportionately high number of these infections. While drug-resistant malaria has been recorded in Southeast Asia, Africa has managed to evade it, until now it would seem.
A new paper, published in the New England Journal of Medicine, has documented what the authors say is the first recorded case of artemisinin-resistant malaria discovered in Africa. The patient, a Chinese national who recently returned from Equatorial Guinea, was admitted to the hospital in Jiangsu Province, China, where he had to be treated no less than six times before he was cleared of the parasite.
What is concerning is that the strain of the malaria-causing agent, Plasmodium falciparum, was resistant to artemisinin combination therapy, which is often the first line of defense against the parasite and widely used across much of Africa. The fear now is that drug-resistant malaria is far more prevalent in the continent that anyone thought.
“The spread of artemisinin resistance in Africa would be a major setback in the fight against malaria, as ACT (artemisinin-based combination therapy) is the only effective and widely used antimalarial treatment at the moment,” explained lead author Arnab Pain, professor at the King Abdullah University of Science and Technology, in a statement. “Therefore, it is very important to regularly monitor artemisinin resistance worldwide.”
This latest study comes not long after another study that found the first case of drug-resistant malaria in the UK. The four patients involved in that study had also just returned from Africa, and at the time the doctors who treated them warned that this could be just the tip of the iceberg in terms of the prevalence of resistant malaria in the continent. It now looks likely that their worse concerns have come to pass.
The move now should be to have a wide-scale assessment of people with malaria in Africa in order to try and ascertain just how prevalent resistance may be. The fact that there has been little evidence up until the last few months for drug-resistant malaria in Africa is worrying, as it may suggest that others have occurred but have simply not been reported.
There is more than one line of defense against the disease, but doctors should be aware of what they are dealing with, especially if they are treating patients who are either in Africa or have just returned from Africa. The next stage is to step up surveillance and to keep on top of the developing situation.
