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15 January 2004

Volume 189, Number 2
The Journal of Infectious Diseases 2004;189:195–203
© 2004 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2004/18902-0005$15.00
DOI: 10.1086/380910
MAJOR ARTICLE

Plasmodium falciparum Clonal Population Dynamics during Malaria Treatment

Sayeh Jafari,

Jacques Le Bras,

Olivier Bouchaud, and

Rémy Durand

Centre National de Référence pour la Chimiosensibilité du Paludisme, Université Paris V et Assistance Publique‐Hôpitaux de Paris, Hôpital Bichat‐Claude Bernard, Laboratoire de Parasitologie, Paris, France

We have developed a new fragment‐analysis method to enumerate the clones and to quantify their proportions within Plasmodium falciparum isolates. We prospectively enrolled 20 adult patients with uncomplicated malaria who were returning to France from various sub‐Saharan countries, from January 2000 through July 2001. The analysis of clonal populations was performed on blood samples obtained at 10 times: 1 before treatment with oral quinine and 9 during the first 96 h of the treatment. The resistance genotypes pfcrt and dhfr were determined for chloroquine and antifolinics. Multiple P. falciparum genotypes were detected in 19 (95%) of 20 patients: 2, 3, 4, and 5 genotypes were found in 4, 9, 4 and 2 patients, respectively. Disappearance and reappearance of some clones within a few hours was observed. Individual clones represented 0.4%–99.4% of total parasitemia. Surprisingly, in 10 of 15 subjects tested, resistance genotypes varied according to the time of blood collection. These findings may have important implications with regard to the interpretations of resistance studies.

Received 11 June 2003; accepted 25 July 2003; electronically published 8 January 2004.

Reprints or correspondence: Dr. Rémy Durand, Hôpital Bichat‐Claude Bernard, Laboratoire de Parasitologie, 46 rue Henri Huchard, 75877 Paris Cedex 18, France ().

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  • Financial support: French Ministry of Health (Direction de la Veille Sanitaire); French Ministry of Research and Technology (Virus de l'Immunodeficiency Humaine‐Paludisme); Leon Mba Institut de Médecine et d’Epidémiologie Africaine Foundation; World Health Organization/Tropical Disease Research (research training grant to S.J.).

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