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Deaths from malaria remain staggering despite global support that drives research into new territories. One major gap is our understanding of the sexual biological aspects of the male mosquito, which maintain the vector population solidity. Although Anopheles funestus s.s. is an extremely efficient African vector, little is known about the network between its sexual physiology and gene expression. The Culicidae male's sexual maturity involves a suite of physiological changes, such as genitalia rotation that is necessary for successful mating to occur. We show that mating success is guided by genes and physiological plasticity. Transcriptome analysis between newly emerged males (immature) versus males with rotating genitalia (maturing) provides insight into possible molecular mechanisms regulating male sexual behaviour. Putative transcripts that were associated with male sexual maturation were identified and validated. The discovery of the functions of these transcripts could lead to identifying potential targets for innovative vector control interventions, and mosquito population suppression.

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OBJECTIVES: Increasing antimicrobial resistance has become a looming threat to paediatric health and, therefore, health facilities are obliged to practice antimicrobial stewardship. This study was undertaken to review stewardship adherence in the Department of Pediatrics at the Central Hospital, Pretoria, South Africa. METHODS: Antibiotic prescriptions of children admitted to hospital were reviewed for consistency with the national essential medicines list from January 2017 to January 2019. Medical records of children were reviewed to obtain the primary diagnosis, requested laboratory investigations and antibiotic prescription practices. The management was adjudicated as consistent with policy by a score system. RESULTS: This study reveals that management was in agreement with standard guidelines in 69.3% of cases, with a range of 33-77%. From the start of the study in January 2017 to the final date in January 2019 there was a significant increase in the number of patients with respiratory tract infections who were treated correctly, increasing from 41% to 73% at study end. CONCLUSIONS: This study is the first to report the success of antibiotic stewardship in children admitted to a tertiary hospital in South Africa. However, it is critical that antibiotic stewardship be continued and antibiotic prescriptions be aligned with guidelines.

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Species of the genus Anopheles vary with regard to their vector capacity for Plasmodium spp., the causative agent of malaria, and their accurate identification is often required. Loop-mediated isothermal amplification (LAMP) is a rapid, simple and low-cost method for specific DNA amplification. Primers for LAMP assays specific for the Anopheles funestus group and Anopheles gambiae complex species as well as for the species Anopheles arabiensis, An. funestus, An. gambiae s.s/Anopheles coluzzii (major vectors) and Anopheles rivulorum (minor vector) were designed targeting specific genome or rDNA internal transcribed spacer regions. Reaction conditions (buffer composition, primer concentrations, incubation time) were evaluated and the specificities of the assays confirmed with DNA from non-target Anopheles species. DNA release from the mosquitoes is achieved simply by heating them for 5 min in water. An aliquot of the DNA solutions is transferred to the reaction tube using disposable inoculation loops. The outcome of the LAMP amplifications after 1 h incubation at 65 °C can easily be visualized by a colour change visible to the naked eye. The assays are operable under field conditions requiring only basic equipment (portable heat block programmable at 65 and 80 °C, cooler for master mixes).

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An efficient sexing system is important for the release of sterile males for any control programme using the sterile insect technique. This study describes the development and characterization of a new genetic sexing strain from South Africa (GMK), needed for the planned implementation of such a programme in northern KwaZulu-Natal Province. The base colony used was a locally modified laboratory strain of Anopheles arabiensis containing a sex-linked gene conferring dieldrin resistance to male mosquitoes. Female A. arabiensis mosquitoes from northern KwaZulu-Natal were mated with these males and backcrossed to introduce the dieldrin resistance gene to the Y chromosome. The resulting strain therefore had an overall genotype representing the local population but with the Y chromosome containing the dieldrin resistance gene. Life-history characteristics, stability of the sex-linked resistance marker, and reduction in dieldrin waste were investigated. The strain showed semi-sterility exhibited by low egg hatch rates, faster development in the immature stages and longer adult survivorship compared with the parental strains. While the GMK strain carrying the dieldrin-resistant gene was successfully established, the stability of the gene is limited, requiring periodic purification. Dieldrin waste can be limited by treating many more eggs than currently recommended.

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The Anopheles funestus group (Diptera: Culicidae) is one of the main species groups involved in malaria transmission in the Afrotropical regions. Basic research into this group has been limited because its members are eurygamic (they tend not to mate in confined spaces), which makes laboratory colonization difficult. Currently, only a few An. funestus Giles colonies are available and no colonies of other members of the group have been established. As information on the larval biology of members of the An. funestus group is limited, the present study aims to determine the effects of different salt concentrations on survival rates of the aquatic stages of two members of the An. funestus group, Anopheles funestus and Anopheles rivulorum Leeson. There were statistically significant negative trends in hatch rate and larval survival rate in An. funestus with increasing salt concentrations, with no larvae surviving to pupae at concentrations that included >15% seawater. Anopheles rivulorum, by contrast, showed no significant trends in hatch rate or larval survival with increasing salt concentrations. This is the first report on salinity tolerance in An. rivulorum. A basic understanding of these variations in salinity tolerance provides vital information on the biology, ecology and colony rearing of members of the An. funestus group.

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Malaria vector control is primarily insecticide based and relies on indoor residual spraying (IRS) and the distribution of long-lasting insecticide-treated bednets (LLINs). These interventions have generally proved effective where appropriately implemented. However, the increasing incidence of insecticide resistance in target vector populations can, and in several cases already has, undermined the effectiveness of IRS and LLINs. Today there are very few localities on the African continent where populations of vector mosquitoes are still susceptible to the approved classes of insecticides. If elimination is to be achieved, SA needs to invest more resources into malaria control. 

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Anopheles funestus is a major vector of malaria in most of the African region. Resistance to pyrethroid and carbamate insecticides has been recorded in populations of this species in South Africa and Mozambique. The P450 gene, CYP6P9, has been shown to be highly transcribed in a permethrin (pyrethroid)-resistant laboratory strain, FUMOZ-R, originating from southern Mozambique. We examined the relationship between pyrethroid resistance and gene transcription levels of two closely related genes, CYP6P9 and CYP6P13, in FUMOZ-R. Levels of resistance to 0.75% permethrin were determined based on standard WHO insecticide susceptibility assays using females and males of different ages, ranging from 3 to 30 days old. The transcription levels of the two genes were quantified using qPCR for each age cohort. In the WHO insecticide susceptibility assays, survival of both males and females significantly decreased as age increased. Quantitative analysis of the two genes CYP6P9 and CYP6P13 showed the highest levels of expression at 10 days of age. There was no correlation between expression of these two genes and pyrethroid survival by age. We conclude that the resistance of this mosquito strain to permethrin is not directly related to age-mediated differences in CYP6P9 and CYP6P13 expression.

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Anopheles funestus, one of the main African malaria vectors, caused a major malaria outbreak in South Africa during 1999/2000, even though South Africa had an effective vector control program in place. The outbreak was due to pyrethroid resistant An. funestus invading KwaZulu/Natal. Increased activity of cytochrome P450 (monooxygenase) was responsible for the pyrethroid resistance in this species. A monooxygenase gene, CYP6P9, was highly overexpressed in the pyrethroid-resistant strain compared with a susceptible strain. Characterization of this gene as well as the redox partners involved in the catalytic cycle of P450s was investigated. The full length of the CYP6P9 sequence was isolated, sequenced and compared between the pyrethroid-resistant and -susceptible strains. Sequence identity between the two strains was 99.3%; the sequence differences were mainly outside of the conserved regions. The functional significance is still unknown, but it is feasible that these variations are associated with differences in insecticide metabolism. A second CYP6 gene (CYP6P13) was also isolated; it shared close similarities with CYP6P9. The putative redox partners, cytochrome b(5) (cyt b(5)) and NADPH-cytochrome P450 reductase (CPR), were isolated from An. funestus (resistant strain) and showed high levels of sequence identity to other insect cyt b(5) and CPRs. Isolation of the coding sequences CYP6P9 and its cognate redox partners enables expression of functional recombinant protein for biochemical and structural analysis.

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This study provides data on malaria vector species composition and insecticide susceptibility status from three localities in Guinea Conakry. A total of 497 mosquitoes were collected resting indoors and morphologically identified as belonging to the Anopheles gambiae complex. The majority of these were An. gambiae s.s. (99.6%), but a small percentage (0.4%) were identified as Anopheles arabiensis. Thirty-four Anopheles funestus s.s. were also collected. The molecular S form of An. gambiae s.s. was predominant over the M form in Siguiri (95%) and Boffa (97.4%), whereas at Mt Nimba the M form was more abundant (61.4%) than the S form (38.1%). One hybrid M/S specimen was recorded from Mt Nimba. Siguiri populations showed high levels of resistance to DDT, dieldrin and bendiocarb. Anopheles gambiae from Boffa were largely susceptible to the insecticides tested. At Mt Nimba, resistance to DDT and bendicocarb was detected. Biochemical enzyme analysis showed that an altered acetylcholinesterase is operating in the field at low levels. The frequency of the 1014F kdr allele in the An. gambiae S form was 0.24 at Siguiri and 0.14 at Mt Nimba. A single RR specimen was found in the M form. The heterogeneity in species composition and resistance profiles between sites requires vector control interventions to be tailored to each site based on the data collected from ongoing monitoring and surveillance.

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House-resting Anopheles mosquitoes are targeted for vector control interventions; however, without proper species identification, the importance of these Anopheles to malaria transmission is unknown. Anopheles longipalpis, a non-vector species, has been found in significant numbers resting indoors in houses in southern Zambia, potentially impacting on the utilization of scarce resources for vector control. The identification of An. longipalpis is currently based on classical morphology using minor characteristics in the adult stage and major ones in the larval stage. The close similarity to the major malaria vector An. funestus led to investigations into the development of a molecular assay for identification of An. longipalpis. Molecular analysis of An. longipalpis from South Africa and Zambia revealed marked differences in size and nucleotide sequence in the second internal transcribed spacer (ITS2) region of ribosomal DNA between these two populations, leading to the conclusion that more than one species was being analysed. Phylogenetic analysis showed the Zambian samples aligned with An. funestus, An. vaneedeni and An. parensis, whereas the South African sample aligned with An. leesoni, a species that is considered to be more closely related to the Asian An. minimus subgroup than to the African An. funestus subgroup. Species-specific primers were designed to be used in a multiplex PCR assay to distinguish between these two cryptic species and members of the An. funestus subgroup for which there is already a multiplex PCR assay.

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Pyrethroid insecticide resistance in Anopheles gambiae sensu stricto is a major concern to malaria vector control programmes. Resistance is mainly due to target-site insensitivity arising from a single point mutation, often referred to as knockdown resistance (kdr). Metabolic-based resistance mechanisms have also been implicated in pyrethroid resistance in East Africa and are currently being investigated in West Africa. Here we report the co-occurrence of both resistance mechanisms in a population of An. gambiae s.s. from Nigeria. Bioassay, synergist and biochemical analysis carried out on resistant and susceptible strains of An. gambiae s.s. from the same geographical area revealed >50% of the West African kdr mutation in the resistant mosquitoes but <3% in the susceptible mosquitoes. Resistant mosquitoes synergized using pyperonyl butoxide before permethrin exposure showed a significant increase in mortality compared with the non-synergized. Biochemical assays showed an increased level of monooxygenase but not glutathione-S-transferase or esterase activities in the resistant mosquitoes. Microarray analysis using the An. gambiae detox-chip for expression of detoxifying genes showed five over-expressed genes in the resistant strain when compared with the susceptible one. Two of these, CPLC8 and CPLC#, are cuticular genes not implicated in pyrethroid metabolism in An. gambiae s.s, and could constitute a novel set of candidate genes that warrant further investigation.

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A population of Anopheles arabiensis; a major malaria vector in South Africa; was collected during 2005 from inside sprayed houses in Mamfene; northern KwaZulu-Natal; South Africa; using window exit traps. None of these specimens (n = 300 females) was found to be infected with Plasmodium falciparum. Insecticide susceptibility assays on 2-3 day old F1 progeny usingWHOsusceptibility kits revealed 100susceptibility to bendiocarb; resistance to deltamethrin (95.91) was suspected; while resistance to permethrin (78.05) was confirmed. The knockdown resistant (kdr) genotype was not found in the surviving mosquitoes. Biochemical analysis using enzyme assays showed elevated levels of monooxygenase that correlated with the permethrin bioassay data. While elevated levels of non-specific esterase were found in some families (11/12 for a- and 6/12 for Beta-esterases); the data did not show any correlation with the permethrin bioassay. Analysis of permethrin and bendiocarb tolerant lines; selected in the laboratory to characterise biochemical resistance profiles; showed increased levels of non-specific esterase and monooxygenase activity in the case of the permethrin-selected cohorts; and elevated glutathione S-transferases and general esterases in that of the bendiocarb-selected line. Synergist assays; using piperonyl butoxide; confirmed the involvement of monooxygenase and glutathione S-transferase in pyrethroid and bendiocarb resistance. This study underlines the importance of routine surveillance for insecticide susceptibility in wild anopheline populations

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Anopheles funestus Giles is one of the major African malaria vectors. It has previously been implicated in a major outbreak of malaria in KwaZulu/Natal, South Africa, during the period 1996 to 2000. The re-emergence of this vector was associated with monooxygenase-based resistance to pyrethroid insecticides. We have identified a gene from the monooxygenase CYP6 family, CYP6P9, which is over expressed in a pyrethroid resistant strain originating from Mozambique. Quantitative Real-Time PCR shows that this gene is highly over expressed in the egg and adult stages of the resistant strain relative to the susceptible strain but the larval stages showed almost no difference in expression between strains. This gene is genetically linked to a major locus associated with pyrethroid resistance in this A. funestus population.

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Species composition, blood meal source, sporozoite infection rate, insecticide resistance and the kdr mutations were investigated in the Anopheles gambiae complex from 13 sentinel sites in central Sudan. Species identification revealed that 89.5% of 960 specimens were A. arabiensis. Of 310 indoor resting females, 88.1% were found to have fed on humans, while 10.6% had fed on bovines. The overall sporozoite infection rate from the five localities tested was 2.3%, ranging from 0 to 5.5%. Insecticide susceptibility bioassay results showed 100% mortality on bendiocarb, 54.6-94.2% on permethrin, 55.4-99.1% on DDT and 76.8-100% on malathion. The kdr analysis by PCR and sequencing revealed the presence of the Leu-Phe mutation in both permethrin and DDT bioassays. There was no significant difference in the frequency of kdr (P>0.05) between dead and surviving specimens. These findings have serious implications for the malaria control programmes in Gezira and Sennar states.

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BACKGROUND & OBJECTIVES: Pyrethroid insecticide resistance in the malaria vector Anopheles gambiae Giles is mainly associated with reduced target site sensitivity arising from a single point mutation in the sodium channel gene, often referred to as knockdown resistance (kdr). This resistance mechanism is widespread in West Africa and was reported for the first time in Nigeria in 2002. Here we present changes in the susceptibility/resistance status of the molecular 'M' and 'S' forms of An. gambiae and the frequency of the kdr alleles from 2002-05. METHODS: Adult anophelines were sampled quarterly inside human dwellings from January 2002 to December 2005 and adults reared from wild larvae were identified using morphological keys. Samples belonging to the An. gambiae complex were subjected to PCR assays for species identification and detection of molecular 'M' and 'S' forms. Insecticide susceptibility tests were carried out using standard WHO procedures and test kits only on 2-3 days old adult An. gambiae s.s. reared from larval collections. The kdr genotypes were determined in both live and dead specimens of An. gambiae s.s. using alleles-specific polymerase chain reaction diagnostic tests. RESULTS: The overall collection showed that the molecular 'S' form was predominant (> 60%) but the proportions of both forms in the mosquito populations from 2002-05 were not statistically different. Both forms also occurred throughout the period without apparent relationship to wet or dry season. Insecticide susceptibility tests did not show any significant increase in the resistance status recorded for either Permethrin or DDT from 2002-05, rather, an improvement in the susceptibility status of the mosquitoes to these insecticides was observed from 2004-05 relative to the tests performed in 2002-03. CONCLUSION: The proportion of the molecular 'M' and 'S' form of An. gambiae and the kdr frequencies have not increased significantly from 2002 when it was first reported in Nigeria. However, the findings on susceptible mosquitoes exhibiting the kdr gene need further investigation. Further monitoring of this may provide additional information on the ongoing debate on the possibility of restriction in gene flow and reproductive barriers in these sympatric taxa.

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A colony of Anopheles arabiensis Patton (Diptera: Culicidae) from the Sennar region of Sudan was selected for resistance to dichlorodiphenyltrichloroethane (DDT). Adults from the F-16 generation of the resistant strain were exposed to all four classes of insecticides approved for use in malaria vector control and showed high levels of resistance to them all (24-h mortalities: malathion, 16.7%; bendiocarb, 33.3%; DDT, 12.1%; dieldrin, 0%; deltamethrin, 24.0%; permethrin, 0%). Comparisons between the unselected base colony and the DDT-resistant strain showed elevated glutathione-S-transferase (P<0.05) in both sexes and elevated esterases (P<0.05) in males only. The Leu-Phe mutation in the sodium channel gene was detected by polymerase chain reaction and sequencing, but showed no correlation with the resistant phenotype. These results do not provide any explanation as to why this colony exhibits such widespread resistance and further studies are needed to determine the precise mechanisms involved. The implications for malaria vector control in central Sudan are serious and resistance management (e.g. through the rotational use of different classes of insecticides) is recommended.

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Anopheles gambiae Giles s.s. (Diptera: Culicidae) is one of the principal vectors of malaria in the Ashanti region of central Ghana. High levels of resistance to dieldrin were recorded in a wild-caught sample from Obuasi (south of Kumasi) as well as a laboratory colony established using material from the wild population. Cytogenetic analysis of wild-caught and laboratory samples revealed chromosomal polymorphism for inversions 2La and 2Rb. Although inversion 2La has previously been shown to be associated with dieldrin resistance in certain other laboratory strains originating from West Africa, there was no obvious association between inversion karyotype assortment and the resistance phenotype in the Obuasi population. In addition, polymerase chain reaction analysis indicated the presence of the alanine296 to glycine mutation in the GABA (gamma amino-butyric acid) receptor (which has been mapped to a chromosomal position within inversion 2La). This mutation has previously been shown to be associated with dieldrin resistance in the same An. gambiae laboratory strains of West African origin. Our data show only a weak association between the dieldrin resistance phenotype and the presence of this mutation, suggesting that another dieldrin resistance mechanism is operational in the Obuasi population. Biochemical and synergist exposure assays suggest a metabolic component, probably mediated by monooxygenase P450 enzymes. We conclude that dieldrin resistance in the An. gambiae population of the Obuasi region occurs at a high level - most likely in the absence of selection - and that control of the resistance phenotype is polyfactorial and must include components other than mutations in the GABA receptor locus.

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Malaria control programmes in Africa, for the most part, address only treatment of the disease and supply of insecticide treated bed nets. The impact of these restricted programmes has been limited and new approaches are being advocated, including integrated vector management strategies and partnerships with industry. Mosquito surveys were carried out for AngloGold/Ashanti in preparation for their implementation of an integrated malaria control programme at the Obuasi gold mine in Ghana. Malaria vectors that were collected inside houses were identified to species and molecular forms by PCR, and tested for insecticide resistance using standard WHO bioassays and molecular target site insensitivity (kdr) assays. Species were identified as An. funestus s.s. and An. gambiae S and M forms. The An. gambiae S form samples showed resistance to DDT, pyrethroids and carbamates while An. funestus was resistant to DDT and carbamates. The An. gambiae M form occurred in very low numbers and could not be assessed reliably for resistance. The standard PCR assay for detection of the kdr mutation in An. gambiae S form showed little association with pyrethroid resistance. Subsequent sequencing of the II56 domain containing the kdr mutation from nine surviving mosquitoes showed that eight were homozygous resistant and one heterozygous. This correlated with the bioassay results and with previous studies on West African An. gambiae, but raised concerns about the reliability of the PCR assay for detection of the kdr mutation. As a result of these investigations AngloGold/Ashanti are implementing, in addition to treatment and case management, a vector control programme that includes insecticide resistance management by alternation of various classes of insecticides for house spraying, supply of ITNs, screening of houses and environmental management where appropriate, i.e. integrated vector management.

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A laboratory colony of Anopheles funestus Giles (Diptera: Culicidae) was established in 2000 from material collected from southern Mozambique where pyrethroid resistance had been demonstrated in the wild population. A subsample of the colony was selected for pyrethroid resistance using 0.1% lambda-cyhalothrin. Bioassay susceptibility tests in subsequent generations F(2) to F(4) showed increased resistance with each successive generation. Survival of individual mosquitoes fed only on 10% sugar solution, increased with age up to 4 days, but by day 10 had decreased significantly. However, females that had been mated and given bloodmeals showed no such increase in mortality with age. Biochemical analysis of resistant and susceptible individuals showed increased monooxygenase and glutathione S-transferase activity but no significant correlation with age of the mosquitoes.

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