Review Article Clinical Microbiology and Infectious Diseases Clin Microbiol Infect Dis, 2016 doi: 10.15761/CMID.1000110 Volume 1(2): 45-55 ISSN: 2398-8096 Emergence of drug resistance in Plasmodiun falciparum: Reasons of its dispersal and transmission in diferent climatic regions of the world: a review Ravi K. Upadhyay* Department of Zoology, D.D.U. Gorakhpur University, Gorakhpur-273009, U.P, India Abstract In the present time emergence, dispersal and transmission of drug resistant malaria parasite P. falciparum has become a serious health problem in human being throughout the globe. From various surveys it has been proved that intensity of drug resistance and pathogenesis of dreadful parasite is increasing day by day due to arousal of point mutations in dhfr and dhps genes mainly drug binding regions of P. falciparum genome. However, single or their multiple point mutations have altered the allele frequencies in P. falciparum clinical isolates collected from various regions of the world that resulted in emergence of drug resistance and lead to complete failures of anti-malarial drugs. Further it has increased dispersal and transmission of drug resistant P. falciparum throughout Africa and Asia. Genetic reasons of drug failures the intensity of parasite survival and its resistance to various drugs seems to be widely infuenced due to climatic and demographic reasons mainly rapid and active breeding of disease transmission vectors, poor health hygienic conditions, use of substandard diagnostic facilities and low grade treatments provided to the patients. In addition, human migration and poor rehabilitation have enhanced the severity and complications of malaria and its seasonal outbreaks. Terefore, for fast control of malaria, high quality diagnostic and treatment facilities are required for better therapeutic results to fght against deadly P. falciparum outbreaks. Correspondence to: Ravi K. Upadhyay, Department of Zoology, D.D.U. Gorakhpur University, Gorakhpur-273009, U.P, India, E-mail: rkupadhya@yahoo.com Key words: malaria, P. falciparum, drug resistance, pyrimethamine- sulfadoxine, chloroquine Received: July 06, 2016; Accepted: July 31, 2016; Published: August 04, 2016 Introduction Malaria is a dreadful infectious disease and has become a major impediment to socio-economic development in Africa, Asia and other poor nations of the world. Today it has become a global burden as an estimated 359 million cases are reported every year and 1.5-2.0 million deaths annually globally. Most of these deaths are largely concerned to the African countries [1]. Recent emergence of resistance to both old and new anti-malarial and its subsequent spread to non-infecting areas undoubtedly make the situation more terrible. Intervention by WHO and other malaria controlling agencies/institutions, it still exists as endemic diseases in densely populated South-East Asian and Sub Saharan African countries. In both the regions malaria became highly problematic due to eruption of multi-drug resistant P. falciparum mutants. Few countries, like Bangladesh, Myanmar, Philippines, Tailand, Cambodia, Eastern India, Indo-Nepal border, and Myanmar-China border become the breeding ground of multi-drug resistant Plasmodium falciparum. Recent detection of ACT resistance in P. falciparum has made the situation more alarming. However, due to long term over and repetitive use of antibiotics, malaria parasites have become resistant to most of them. It has further reduced the drug efcacy and increased the drug dose/level mainly IC 50 values manifold. Subsequently, it has resulted in an increased rapid dispersal and transmission of drug resistant falciparum malaria [2]. Teir drug- resistant pfdhps haplotypes are circulating in West Africa and many Asian countries. Terefore, afer seeing the rapid spread of multi-drug resistant P. falciparum mostly in poor countries of the world, it become mandatory to design new anti-malarial drugs with new viable strategies to check the emergence and spread of future drug resistance. All new alternative drugs need to be tested for their efcacy [3] to control high infection rate acquired by malaria parasite [4]. Besides this, there is a vast diference in drug sensitivity of parasites in many regions and it varies from region to region [5]. In some of the pockets same drug is thought to be efective but again it has no efect in other neighboring country. All it is due to increased drug pressure that has induced genomic changes mainly in dhfr and dhps genes at regional level. Terefore, there is an urgent need to collect molecular epidemiological information from diferent countries for quick analysis of data to know all possible reasons of origin and spread of drug resistant malaria [6]. Spread of multidrug resistant malaria in Asia and Africa Due to demographic, eco-climatic and genetic reasons multidrug resistant malaria is widely spreading in Asia and Africa and rest of the world [7]. Mainly mutations occurred in dhfr and dhps genes conferred high levels of resistance in malaria parasite. It has increased density of malaria parasite in patients; hence, malaria treatment has become very difcult [8]. Tese genetically resistant infectious strains of P. falciparum malaria are reported from many countries of the world such as Mali [9], Sub-Saharan Africa [10], Somalia [11], Tailand [12], Mozambique [13], Rwanda [14], Swaziland [15], Soloman islands [16], Iran [17], Nigeria [18] and Kenya [19]. Besides this, Trimethoporin