Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar.
Chloroquine-primaquine (CQ-PQ) continues to be the frontline therapy for radical cure of Plasmodium vivax malaria. Emergence of CQ-resistant (CQR) P. vivax parasites requires shifting to artemisinin combination therapies (ACTs), which imposes a significant financial, logistical, and safety burden. M...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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2014
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| _version_ | 1797090680897536000 |
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| author | Yuan, L Wang, Y Parker, D Gupta, B Yang, Z Liu, H Fan, Q Cao, Y Xiao, Y Lee, M Zhou, G Yan, G Baird, J Cui, L |
| author_facet | Yuan, L Wang, Y Parker, D Gupta, B Yang, Z Liu, H Fan, Q Cao, Y Xiao, Y Lee, M Zhou, G Yan, G Baird, J Cui, L |
| author_sort | Yuan, L |
| collection | OXFORD |
| description | Chloroquine-primaquine (CQ-PQ) continues to be the frontline therapy for radical cure of Plasmodium vivax malaria. Emergence of CQ-resistant (CQR) P. vivax parasites requires shifting to artemisinin combination therapies (ACTs), which imposes a significant financial, logistical, and safety burden. Monitoring therapeutic efficacy of CQ is thus important. Here we evaluated therapeutic efficacy of CQ-PQ for P. vivax malaria in northeast Myanmar. We recruited 587 patients with P. vivax mono-infection attending local malaria clinics during 2012-2013. These patients received three daily doses of CQ at a total dose of 24 mg base/kg body weight and an 8-day PQ treatment (0.375 mg/kg/day) commencing at the same time as first CQ dose. Of the 401 patients who finished 28-day follow-up, the cumulative incidence of recurrent parasitemia was 5.20% (95% CI, 3.04%-7.36%). Among 361 (61%) patients finishing 42-day follow-up, the cumulative incidence of recurrent blood stage infection reached 7.98% (95% CI, 5.20%-10.76%). The cumulative risk of gametocyte carriage at day 28 and 42 was 2.21% (95% CI, 0.78%-3.64%) and 3.93% (95% CI, 1.94%-5.92%), respectively. Interestingly, all 15 patients with recurrent gametocytemias were associated with concurrent asexual stages. Genotyping of recurrent parasites at the merozoite surface protein 3α locus among 12 patients with recurrent parasitemia within 28 days revealed that 10 of these were the same genotype as day 0, suggesting of recrudescence or relapse. Similar studies in 70 patients in the same area in 2007 showed no recurrent parasitemias within 28 days. Sensitivity to chloroquine of P. vivax in northeastern Myanmar may be deteriorating. |
| first_indexed | 2024-03-07T03:22:10Z |
| format | Journal article |
| id | oxford-uuid:b7ccaa5a-a294-4dec-91e9-fd408af2d791 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:22:10Z |
| publishDate | 2014 |
| record_format | dspace |
| spelling | oxford-uuid:b7ccaa5a-a294-4dec-91e9-fd408af2d7912022-03-27T04:51:12ZTherapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b7ccaa5a-a294-4dec-91e9-fd408af2d791EnglishSymplectic Elements at Oxford2014Yuan, LWang, YParker, DGupta, BYang, ZLiu, HFan, QCao, YXiao, YLee, MZhou, GYan, GBaird, JCui, LChloroquine-primaquine (CQ-PQ) continues to be the frontline therapy for radical cure of Plasmodium vivax malaria. Emergence of CQ-resistant (CQR) P. vivax parasites requires shifting to artemisinin combination therapies (ACTs), which imposes a significant financial, logistical, and safety burden. Monitoring therapeutic efficacy of CQ is thus important. Here we evaluated therapeutic efficacy of CQ-PQ for P. vivax malaria in northeast Myanmar. We recruited 587 patients with P. vivax mono-infection attending local malaria clinics during 2012-2013. These patients received three daily doses of CQ at a total dose of 24 mg base/kg body weight and an 8-day PQ treatment (0.375 mg/kg/day) commencing at the same time as first CQ dose. Of the 401 patients who finished 28-day follow-up, the cumulative incidence of recurrent parasitemia was 5.20% (95% CI, 3.04%-7.36%). Among 361 (61%) patients finishing 42-day follow-up, the cumulative incidence of recurrent blood stage infection reached 7.98% (95% CI, 5.20%-10.76%). The cumulative risk of gametocyte carriage at day 28 and 42 was 2.21% (95% CI, 0.78%-3.64%) and 3.93% (95% CI, 1.94%-5.92%), respectively. Interestingly, all 15 patients with recurrent gametocytemias were associated with concurrent asexual stages. Genotyping of recurrent parasites at the merozoite surface protein 3α locus among 12 patients with recurrent parasitemia within 28 days revealed that 10 of these were the same genotype as day 0, suggesting of recrudescence or relapse. Similar studies in 70 patients in the same area in 2007 showed no recurrent parasitemias within 28 days. Sensitivity to chloroquine of P. vivax in northeastern Myanmar may be deteriorating. |
| spellingShingle | Yuan, L Wang, Y Parker, D Gupta, B Yang, Z Liu, H Fan, Q Cao, Y Xiao, Y Lee, M Zhou, G Yan, G Baird, J Cui, L Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title | Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title_full | Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title_fullStr | Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title_full_unstemmed | Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title_short | Therapeutic Responses of Plasmodium vivax Malaria to Chloroquine and Primaquine Treatment in Northeastern Myanmar. |
| title_sort | therapeutic responses of plasmodium vivax malaria to chloroquine and primaquine treatment in northeastern myanmar |
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