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Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.

Tun KM, Imwong M, Lwin KM, Win AA, Hlaing TM, Hlaing T, Lin K, Kyaw MP, Plewes K, Faiz MA, Dhorda M, Cheah PY, Pukrittayakamee S, Ashley EA, Anderson TJ, Nair S, McDew-White M, Flegg JA, Grist EP, Guerin P, Maude RJ, Smithuis F, Dondorp AM, Day NP, Nosten F, White NJ, Woodrow CJ - Lancet Infect Dis (2015)

Bottom Line: Artemisinin resistance extends across much of Myanmar.Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided.Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme and the Bill & Melinda Gates Foundation.

View Article: PubMed Central - PubMed

Affiliation: Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Defence Services Medical Research Centre, Naypyitaw, Myanmar.

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Geographical extent of predicted artemisinin resistance as determined by the prevalence of K13 propeller mutations (>440 aminoacids) visualised by approaches using a Bayesian model (A, with uncertainty shown in B) and kriging interpolation (C, with uncertainty shown in D)In the main prevalence maps, colour shows total prevalence of relevant K13 mutations (median in A and mean in C). In the uncertainty maps, orange and red areas show the greatest uncertainty in Shan State (in the east) and the southern peninsula. In A the colour of the circles is proportional to the recorded K13-mutation prevalence at a particular site and the radius of the circle is proportional to the sample size of the study.
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fig4: Geographical extent of predicted artemisinin resistance as determined by the prevalence of K13 propeller mutations (>440 aminoacids) visualised by approaches using a Bayesian model (A, with uncertainty shown in B) and kriging interpolation (C, with uncertainty shown in D)In the main prevalence maps, colour shows total prevalence of relevant K13 mutations (median in A and mean in C). In the uncertainty maps, orange and red areas show the greatest uncertainty in Shan State (in the east) and the southern peninsula. In A the colour of the circles is proportional to the recorded K13-mutation prevalence at a particular site and the radius of the circle is proportional to the sample size of the study.

Mentions: We calculated the total prevalence of K13-propeller mutations for each administrative region (table) and site as the proportion of samples with any mutation after aminoacid 440. We entered these point metrics into two independent geospatial models to obtain continuous prevalence maps for Myanmar (figure 4). Both maps showed a large area of fairly high mutation prevalence (substantially more than 10%) extending from the southeast to the north of the country (figure 4). Much of Lower Myanmar, and Chin and Rakhine states in the west, had a very low prevalence of K13 mutations, a finding consistent with the absence of K13 mutant parasites in adjacent Bangladesh (figure 4).


Spread of artemisinin-resistant Plasmodium falciparum in Myanmar: a cross-sectional survey of the K13 molecular marker.

Tun KM, Imwong M, Lwin KM, Win AA, Hlaing TM, Hlaing T, Lin K, Kyaw MP, Plewes K, Faiz MA, Dhorda M, Cheah PY, Pukrittayakamee S, Ashley EA, Anderson TJ, Nair S, McDew-White M, Flegg JA, Grist EP, Guerin P, Maude RJ, Smithuis F, Dondorp AM, Day NP, Nosten F, White NJ, Woodrow CJ - Lancet Infect Dis (2015)

Geographical extent of predicted artemisinin resistance as determined by the prevalence of K13 propeller mutations (>440 aminoacids) visualised by approaches using a Bayesian model (A, with uncertainty shown in B) and kriging interpolation (C, with uncertainty shown in D)In the main prevalence maps, colour shows total prevalence of relevant K13 mutations (median in A and mean in C). In the uncertainty maps, orange and red areas show the greatest uncertainty in Shan State (in the east) and the southern peninsula. In A the colour of the circles is proportional to the recorded K13-mutation prevalence at a particular site and the radius of the circle is proportional to the sample size of the study.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374103&req=5

fig4: Geographical extent of predicted artemisinin resistance as determined by the prevalence of K13 propeller mutations (>440 aminoacids) visualised by approaches using a Bayesian model (A, with uncertainty shown in B) and kriging interpolation (C, with uncertainty shown in D)In the main prevalence maps, colour shows total prevalence of relevant K13 mutations (median in A and mean in C). In the uncertainty maps, orange and red areas show the greatest uncertainty in Shan State (in the east) and the southern peninsula. In A the colour of the circles is proportional to the recorded K13-mutation prevalence at a particular site and the radius of the circle is proportional to the sample size of the study.
Mentions: We calculated the total prevalence of K13-propeller mutations for each administrative region (table) and site as the proportion of samples with any mutation after aminoacid 440. We entered these point metrics into two independent geospatial models to obtain continuous prevalence maps for Myanmar (figure 4). Both maps showed a large area of fairly high mutation prevalence (substantially more than 10%) extending from the southeast to the north of the country (figure 4). Much of Lower Myanmar, and Chin and Rakhine states in the west, had a very low prevalence of K13 mutations, a finding consistent with the absence of K13 mutant parasites in adjacent Bangladesh (figure 4).

Bottom Line: Artemisinin resistance extends across much of Myanmar.Appropriate therapeutic regimens should be tested urgently and implemented comprehensively if spread of artemisinin resistance to other regions is to be avoided.Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Programme and the Bill & Melinda Gates Foundation.

View Article: PubMed Central - PubMed

Affiliation: Myanmar Oxford Clinical Research Unit, Yangon, Myanmar; Defence Services Medical Research Centre, Naypyitaw, Myanmar.

Show MeSH
Related in: MedlinePlus