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National guidelines recommend the combination of chloroquine and primaquine (CQ-PQ) for radical treatment of<jats:italic>P. vivax<\/jats:italic>malaria. Artesunate in combination with the antifolates sulfadoxine-pyrimethamine (SP) has been first-line treatment for uncomplicated falciparum malaria until 2016. Although SP has been the recommended treatment for falciparum and not vivax malaria, exposure of the<jats:italic>P. vivax<\/jats:italic>parasite population to SP might still have been quite extensive because of community based management of malaria. The change in the<jats:italic>P. vivax<\/jats:italic>antifolate resistance markers between 2007 and 2017 were investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Dried blood spots were collected (n\u2009=\u2009185) from confirmed<jats:italic>P. vivax<\/jats:italic>patients in five malaria-endemic areas of Afghanistan bordering Tajikistan, Turkmenistan and Pakistan, including Takhar, Faryab, Laghman, Nangarhar, and Kunar, in 2007, 2010 and 2017. Semi-nested PCR, RFLP and nucleotide sequencing were used to assess the pyrimethamine resistant related mutations in<jats:italic>P. vivax dihydrofolate reductase<\/jats:italic>(<jats:italic>pvdhfr<\/jats:italic>I13L, P33L, N50I, F57L, S58R, T61I, S93H, S117N, I173L) and the sulfonamide resistance related mutations in<jats:italic>P. vivax dihydropteroate synthase<\/jats:italic>(<jats:italic>pvdhps<\/jats:italic>A383G, A553G).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 185 samples genotyped for<jats:italic>pvdhfr<\/jats:italic>and<jats:italic>pvdhps<\/jats:italic>mutations<jats:italic>,<\/jats:italic>11 distinct haplotypes were observed, which evolved over time. In 2007, wild type<jats:italic>pvdhfr<\/jats:italic>and<jats:italic>pvdhps<\/jats:italic>were the most frequent haplotype in all study sites (81%, 80\/99). However, in 2017, the frequency of the wild-type was reduced to 36%, (21\/58;<jats:italic>p<\/jats:italic>value\u2009\u2264\u20090.001), with an increase in frequency of the double mutant<jats:italic>pvdhfr<\/jats:italic>and<jats:italic>pvdhps<\/jats:italic>haplotype S58RS117N (21%, 12\/58), and the single<jats:italic>pvdhfr<\/jats:italic>mutant haplotype S117N (14%, 8\/58). Triple and quadruple mutations were not found. In addition,<jats:italic>pvdhfr<\/jats:italic>mutations at position N50I (7%, 13\/185) and the novel mutation S93H (6%, 11\/185) were observed. Based on in silico protein modelling and molecular docking, the<jats:italic>pvdhfr<\/jats:italic>N50I mutation is expected to affect only moderately pyrimethamine binding, whereas the S93H mutation does not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the course of ten years, there has been a strong increase in the frequency pyrimethamine resistance related mutations in<jats:italic>pvdhfr<\/jats:italic>in the<jats:italic>P. vivax<\/jats:italic>population in Afghanistan, although triple and quadruple mutations conferring high grade resistance were not observed. This suggests relatively low drug pressure from SP on the<jats:italic>P. vivax<\/jats:italic>parasite population in the study areas. The impact of two newly identified mutations in the<jats:italic>pvdhfr<\/jats:italic>gene on pyrimethamine resistance needs further investigation.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12936-020-03319-0","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T13:38:34Z","timestamp":1594733914000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Polymorphisms in Plasmodium vivax antifolate resistance markers in Afghanistan between 2007 and 2017"],"prefix":"10.1186","volume":"19","author":[{"given":"Kasama","family":"Rakmark","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghulam R.","family":"Awab","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jureeporn","family":"Duanguppama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Usa","family":"Boonyuen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arjen M.","family":"Dondorp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-1855","authenticated-orcid":false,"given":"Mallika","family":"Imwong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"3319_CR1","volume-title":"World malaria report 2018","author":"WHO","year":"2018","unstructured":"WHO. 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PLoS Pathog. 2006;2:e57.","journal-title":"PLoS Pathog"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-020-03319-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-020-03319-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-020-03319-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,10]],"date-time":"2024-08-10T01:47:12Z","timestamp":1723254432000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-020-03319-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,14]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["3319"],"URL":"https:\/\/doi.org\/10.1186\/s12936-020-03319-0","relation":{},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,14]]},"assertion":[{"value":"21 April 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical and Scientific procedure of this study were certificated by the ethics committee of the Faculty of Tropical Medicine, Mahidol University, Thailand. The sample materials used in this study were approved by the ethical committee from Department of Disease Control, Ministry of Public Health, and Afghanistan.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"251"}}