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July 28, 2017 - 20:14 -- Irene Teis

Thank you MP for your blog http://mosquitopundit.net/mosquitopundit-blog/act-and-malaria-recrudesce....

You give me a lot of credit when you state: malaria researcher Irene Teis doesn’t know that her 2 April 2016 post “Was the Nobel prize for artemisinin a fatal error” at www.malariaworld.org helped save at least nine lives.

These are excerpts of your blog: “We know nine people personally, including family members, who in 2016 were treated with Coartem. Everybody had a rapid and reviving recovery, then inexorably began dragging and declining within weeks. Irene Teis doesn’t know this, but reading her post was like being hit by a lightning bolt. We read her warning: it became stunningly obvious : recrudescence, relapse. They were positive for malaria again, after being treated recently for it.

Several papers describe malaria resistance to ACTs in Africa, especially one from Nigeria which calls for the urgent need to re-evaluate the efficacy of ACTs in Nigeria and Sub-Saharan Africa.

Recent papers indeed ring alarm bells. Plasmodium malaria parasites through a step-wise increase in artesunate dose evolve extremely rapidly slow clearance rates. These slower clearance rates provide fitness advantages to the parasite through increased overall density, recrudescence after treatment and increased transmission potential. Removal of only the susceptible parasites by artesunate treatment led to substantial increases in the densities of resistant parasites. (LC Pollitt, S Huijben, A Read, Rapid response to selection and increased transmission potential in artesunate-selected Plasmodium parasites, PloS Pathogens 2014, 10,4, e1004019).

The same research team found that mixed infections also are frequent, not only in humans but also in the mosquito. Mixed strains are obtained after multiple infective bites and accumulate in the mosquito and increase malaria transmission to the vertebrate host, with implications for the evolution of the parasite virulence and the spread of drug resistant strains (LC Pollitt, A Read, Existing infection facilitates establishment and density of malaria parasites in the mosquito vector. PLOS Pathogens, 2015, e1005003)”

MP also quotes a blog from researcher Pierre Lutgen, February 16, 2016 “Artesunate causes recrudescence, Artemisia however kills gametocytes”. A paper from Mali indeed is alarming (AA Djimbe et al., Parasite, 2016. 23, 3). Artesunate does not clear mature gametocytes during oral artesunate treatment and does not prevent the appearance of new gametocytes. This confirms to a large extent the randomized, double blind, large scale clinical trials of Jerôme Munyanga in Maniema-Congo end of last year (see www.malariaworld.org ) After 14 days up to day 28 all gametocytes had completely disappeared in those treated with Artemisia herbal infusion, but *it was still present* on day 28 in 10% of those treated with Coartem.