Doctors in the UK reported this week that four patients, all of whom had travelled to Africa returned to the UK with malaria that subsequent proved totally resistant to front-line anti-malarial drugs.
Doctors and scientists have admitted that this is the first sign of evolving resistance they have seen outside of Africa.
The team, from the London School of Hygiene and Tropical Medicine said it was too early to panic but they also warned that the situation could worsen quickly and called for a complete and urgent review of malarial drug resistance in Africa.
According to a report by the BBC 1,500 and 2,000 people return to the UK each year carrying the malaria parasite. Most respond to a combination drug artemether-lumefantrine.
All four of the patients presented between October 2015 and February 2016. four people in five months may not sound like a lot but you have to consider it has never happened before so to get four people in 20 weeks turning up who have resistance to the treatment is astounding, an average of one person every five weeks is to much in my mind.
The BBC report continues:
All initially responded to therapy and were sent home, but were readmitted around a month later when the infection rebounded.
Samples of the parasite that causes malaria were analysed at the Malaria Reference Laboratory at the London School of Hygiene and Tropical Medicine.
Dr Colin Sutherland told the BBC News website: “It’s remarkable there’s been four apparent failures of treatment, there’s not been any other published account [in the UK].”
All of the patients were eventually treated using other therapies. But the detailed analysis of the parasites suggested they were developing ways of resisting the effects of the front-line drugs.
Dr Sutherland added: “It does feel like something is changing, but we’re not yet in a crisis. It is an early sign and we need to take it quite seriously as it may be snowballing into something with greater impact.”
Well Dr Sutherland may wrap his panic in reassuring words but it is panic nonetheless.
We have mosquitoes in the UK, lots of them, especially in the South of the country and their numbers are increasing year on year. Luckily these cases arrived back in the Uk when the resident population of mosquitoes were inactive, but, had they arrived back in the summer Dr Sutherland may not have been so outwardly calm.
One mosquito biting just one of those people means it picks up the malaria parasite and transfers it to the next person it bites. The fact that the returning travellers had come from different African countries makes the situation even worse. Had they all been to one place it could be considered a “hotspot” and the area could have been targeted to check the levels of drug resistance.
Uganda, Liberia and Angola are thousands of miles apart, there is no possibility that there is a hot spot. The spread is indicative of something far more sinister, a continent wide resistance is developing.
There are already signs of resistance in South East Asia and worryingly it’s evolving differently to the African resistance even though it may have originally arrived in Africa from Asia.
Artemisinin-resistant Plasmodium falciparum parasites are rapidly spreading in Southeast Asia, yet nothing is known about their transmission. This knowledge gap and the possibility that these parasites will spread to Africa endanger global efforts to eliminate malaria.
The ability of artemisinin-resistant parasites to infect such highly diverse Anopheles species, combined with their higher gametocyte prevalence in patients, may explain the rapid expansion of these parasites in Cambodia and neighbouring countries, and further compromise efforts to prevent their global spread. (source)
Malaria kills more than a million people a year, predominantly children from sub-Saharan Africa. (source) but that number will rise alarmingly if resistance to treatment becomes a widespread issue. The consequences of this killer disease becoming untreatable would be catastrophic and not just for those people who live with it’s threat their whole lives.
We need to seriously hope that this trend doesn’t continue.
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