The genetic diversity of Plasmodium falciparum (P falciparum) infections in humans is implicated in the pathogenesis of malaria. This study provides the first estimate of the genetic diversity and genotype multiplicity of Plasmodium falciparum infection in children with uncomplicated P falciparum malaria in Osogbo, Nigeria. One hundred and one isolates were used for analysis of parasite population polymorphism and genotyped by nested-PCR of merozoite surface protein 2 (MSP2) block 3. Amplicons were obtained for all the 101 genotyped samples in MSP2 PCR with 9 alleles varying in size between 300 and 800 base pair. Thirty-three (31.7%) samples had FC27 allele while 27 (26.7%) had 3D7 allele and 35 (34.7%) had mixed alleles (3D7+FC27). The Multiplicity of Infection (MOI) in the population was 1.6. Children in the age group of > 4-8 years had the highest number of different genotypes in their samples (1.8). The number of MSP2 bands per isolate was lower in the older age group (1.3) but the difference was not statistically significant. Children with parasite density range 5001-10 000 had the highest MOI of 2 while those with parasite density range 1000-5000 had the lowest of1.5. In conclusion, the present study shows that the field isolates are highly diverse in respect ofMSP2 and multiplicity of infection was neither age nor parasite density dependent in the study population.

La diversidad genética de las infecciones por Plasmodium falciparum en los humanos se halla implícita en la patogénesis de la malaria. Este estudio proporciona un primer estimado de la diversidad genética y multiplicidad del genotipo de la infección por Plasmodium falciparum en los niños con malaria por P falciparum malaria sin complicaciones en Osogbo, Nigeria. Ciento un aislados fueron usados para el análisis del polimorfismo de la población parasitaria, y genotipificados mediante reacción en cadena de la polimerasa (RCP) anidada de la proteína de superficie del merozoíto 2 (MSP2) bloque 3. Se obtuvieron amplicones para las 101 muestras genotipificadas con RCP de MSP2, con 9 alelos variando en tamaño entre 300 y 800 par de bases. Treinta y tres (31.7%) muestras tenían el alelo FC27 mientras 27 (26.7%) tenían el alelo 3D7 y 35 (34.7%) tenían alelos mezclado (3D7+FC27). La multiplicidad de infección (MOI) en la población fue 1.6. Los niños en el grupo etario de > 4-8 años tenían el número más alto de genotipos diferentes en sus muestras (1.8). El número de bandas de MSP2 por aislado era más bajo en el grupo etario de mayor edad (1.3) pero la diferencia no era estadísticamente significativa. Los niños con un rango de densidad parasitaria 5001-10 000 tenían el MOI más alto equivalente a 2, mientras aquéllos con rango de densidad parasitaria 1000-5000 tenían el MOI más bajo equivalente a 1.5. En conclusión, el presente estudio muestra que los aislados de campo son altamente diversos con respecto al MSP2, y que la multiplicidad de la infección no depende ni de la edad ni de la densidad parasitaria de la población en estudio.

Chloroquine (CQ) resistance in Plasmodium falciparum contributes to increasing malaria-attributable morbidity and mortality in Sub-Saharan Africa. Despite a change in drug policy, continued prescription of CQ did not abate. Therefore the therapeutic efficacy of CQ in uncomplicated falciparum malaria patients was assessed in a standard 28-day protocol in 116 children aged between six and 120 months in Osogbo, Southwest Nigeria. Parasitological and clinical assessments of response to treatment showed that 72 (62.1%) of the patients were cured and 44 (37.9%) failed the CQ treatment. High initial parasite density and young age were independent predictors for early treatment failure. Out of the 44 patients that failed CQ, 24 received amodiaquine + sulphadoxine/pyrimethamine (AQ+SP) and 20 received chlorpheniramine + chloroquine (CH+CQ) combinations. Mean fever clearance time in those treated with AQ+SP was not significantly different from those treated with CH+CQ (p = 0.05). There was no significant difference in the mean parasite density of the two groups. The cure rate for AQ+SP group was 92% while those of CH+CQ was 85%. There was a significant difference in parasite clearance time (p = 0.01) between the two groups. The 38% treatment failure for CQ reported in this study is higher than the 10% recommended by World Health Organization in other to effect change in antimalarial treatment policy. Hence we conclude that CQ can no more be solely relied upon for the treatment of falciparum malaria in Osogbo, Nigeria. AQ+SP and CH+CQ are effective in the treatment of acute uncomplicated malaria and may be considered as useful alternative drugs in the absence of artemisinin-based combination therapies.