Falciparum malaria molecular drug resistance in the Democratic Republic of Congo: a systematic review

peer reviewedBackground: Malaria cases were estimated to 207 million in 2013. One of the problems of malaria control is the emergence and spread of Plasmodium falciparum strains that become resistant to almost all drugs available. Monitoring drug resistance is essential for early detection and subsequent prevention of the spread of drug resistance by timely changes of treatment policy. This review was performed to gather all data available on P. falciparum molecular resistance in DR Congo, as baseline for future assessments. Methods: The search for this review was undertaken using the electronic databases PubMed and Google Scholar using the terms “malaria”, “Congo”, “resistance”, “molecular”, “antimalarial”, “efficacy”. Articles were classified based on year of collecting, year of publication, sample size and characteristics, molecular markers analysed and polymorphisms detected. Results: Thirteen articles were included and five genes have been analysed in these studies: pfcrt, pfdhps, pfdhfr, pfmdr1 and K13-propeller. The majority of studies included were not representative of the whole country. Conclusion: This systematic review demonstrates the lack of molecular resistance studies in DRC. Only 13 studies were identified in almost 15 years. The MOH must implement a national surveillance system for monitoring malaria drug resistance and this surveillance should be conducted frequently and country-representative

Black water fever associated with acute renal failure among Congolese children in Kinshasa

Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics′ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8%) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%). Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate <15 mEq/L) in 61.5% and hyponatremia (<130 mEq/L) in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%), including 20 on dialysis, fully recovered and 14 died (22.2%), including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings

High IgG1 Malaria Antibodies Level in Children is a Possible Risk Factor of Blackwater Fever: A Case-Control Study

peer reviewedContext: Pathogenesis of acute massive intravascular hemolysis in Blackwater fever is very complex. Mostly, Malaria immunity deficiency in expatriates, Quinine and Plasmodium are incriminated. The possible role of malaria IgG1 antibodies in BWF is not fully elucidated. Objectives: This study aimed to determine the profile of malaria IgG1 for malaria crude antigen in children developing blackwater fever compared to patients with uncomplicated malaria Methods: This case-control study was conducted in 4 medical institutions across Kinshasa. Cases were patients with Blackwater fever (BWF) whereas controls had uncomplicated Plasmodium falciparum malaria (UM). For each case, 2 controls were recruited and were matched for age, sex and the area of residence. Malaria IgG1 were assessed by standard ELISA and absorbance measured in an automated plate reader. Results: The majority of BWF cases (81.4%) were above 5 years old while only 18.6% were aged below 5 (OR: 1.33; 0.53-3.32). The level of malaria IgG antibodies in BWF children were significantly higher compared to uncomplicated malaria (p=0.002). Quinine was used by 95.3% of the BWF cases ([OR: 50.19 (10.75-234.42)] p<0.001) versus in uncomplicated malaria. There was no linear correlation between the age of patients and the logarithm of antibodies. R2 is totally null (p=0.335). Conclusion: Malaria IgG1 antibodies is significantly elevated in children with BWF and could trigger the occurrence of BWF. The absence of correlation with age suggests that BWF could not be age dependent