Anti-malarial drug resistance on the Thai-Myanmar border

Malaria is a treatable disease, but in a certain part of South East Asia anti-malarial drugs are becoming less effective as time passes by.

Wellcome, a British biomedical research charity conducted a study on the Thailand-Myanmar border in partnership with Shakolo Malaria Research Unit (SMRU) clinics. After 10 years and 1.005 patients with uncomplicated Plasmodium Falciparum, the researchers have found that genetic mutations in the kelch gene of the malaria parasite have made the parasite resistant to the anti-malarial drug mefloquine and the drug artesunate. These drugs are typically used in the Artemisinin-based Combination Therapy also known as ACT. It “means that the first-line ACT introduced here in 1994 has finally fallen to resistance.” said Professor Francois Nosten, Director of SMRU. This resistance poses a serious threat to the control and eradication of malaria in the area.

Malaria has been eliminated in most part of the Mekong region but remains a threat along the borders of Myanmar and Thailand. In addition to being heavily forested, the area sees a lot of migration and the few health workers can’t always reach everyone. This lack of human resources, as well as the shortage of reliable microscopic facilities, is one of the main cause of drug resistance. To counterbalance this insufficiency, the study conducted by Nyunt MH* reveals that health providers are mostly using Rapid Diagnostic Tests (RDTs). “However, challenges, including problems of distribution for widespread adoption of diagnostics by RDTs have been reported in many other countries, as has variability in the quality of performance of RDTs, including sensitivity, specificity, heat stability and longevity.” (Ibid.). Inaccuracy in diagnosis leads to overtreatment and treating cases without malaria. This use of ACT contributes to the emergence and the spread of drug-resistant strains.

Easy, accurate and fast diagnosis is the gateway for effective malaria treatment as well as a measure to limit unnecessary drug administration. On top of staff education and drug research, the diffusion of diagnostic tools such as xRapid-Malaria could be the solution for drug resistance. According to xRapid’s early user in Papua Indonesia, being able to use the automated diagnostic app “to know if malaria is involved helps relieve some of my stress when trying to treat patients with limited diagnostic resources, plus appropriate treatment can be given.”

*Nyunt MH and al., 2016, « Challenges Encountered by Local Health Volunteers in Early Diagnosis and Prompt Treatment of Malaria in Myanmar Artemisinin Resistance Containment Zones », Malaria Journal

A disruptive tool to assist researchers in labs

Thanks to a combined effort of governments, researchers, industries and non-governmental organisations progress have been made in malaria research. The world continues however to face many challenges: from anti-malarial drug and vaccine to insecticide resistance. In laboratories, research is making use of cultures of parasites: this involves long and tedious workflows that are somewhat different from the usual diagnostic of a Plasmodium from a thin smear. When we realised that researchers were measuring the parasite count many times a day, we thought we should try to help.

 

 

As a result, xRapid is developing xRapid-Lab, a tool that can count all the red blood cells and parasites of all stages faster than a human eye. It has been a particularly interesting development, certainly benefiting from the interactions with non-clinical researchers: “we realized very quickly that not only xRapid-Lab would be better if we worked alongside specialists of culture, but that this would also be of real benefit to the main Malaria diagnostic app”, says David Mendels, CTO of xRapid. “In fact, we got our hands on highly synchronised samples, which have helped redefine our classification process and speed-up the analysis by an order of magnitude. We are excited to ship these improvements as soon as we are done with testing and validation”.

xRapid-Lab is currently undergoing beta-testing with a few partners, contact us at info@xrapid.com if you would be interested in joining this testing.