Features of recrudescent chloroquine-resistant Plasmodium falciparum infections confer a survival advantage on parasites and have implications for disease control
Features of recrudescent chloroquine-resistant Plasmodium falciparum infections confer a survival advantage on parasites and have implications for disease control
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DOI：
10.1016/s0035-9203(96)90325-9
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发表时间：
1996-09-01
影响因子：
2.2
通讯作者：
Mendis, KN
中科院分区：
文献类型：
--
作者：
Handunnetti, SM;Gunewardena, DM;Mendis, KN
本文报道了对氯喹耐药恶性疟原虫（CQRPf）疟疾复发感染的特点，来自斯里兰卡疟疾流行区（n = 527）和非流行区（n = 129）患者的体内研究，其中RI耐药的发病率分别为30%和55%。在两组患者中，氯喹（CQ）和伯氨喹治疗原发性感染后出现的复发感染与原发性感染（平均寄生虫血症0.13%和0.49%; P = 0.021和0.002）相比，外周寄生虫血症显著降低（地方病和非地方病患者分别为0.036%和0.108%）。CQ耐药感染的复发也导致临床疾病的严重程度显著降低（平均临床评分为10.1和8.2），与其原发感染（平均临床评分为12.4和12.3;在地方病和非地方病患者中，P分别为0.003和0.001）相比。因此，CQ耐药复发感染的诊断和治疗概率较低。在地方病患者中，与氯喹敏感者（29%）相比，CQRPf感染者（57%）有较高比例的配子体血症（P = 0.014 chi（2）= 5.96），并且对蚊子的感染性显著更强（P = 0.047）。这些发现意味着，在CQ耐药性普遍存在的地区，继续使用该药物可能会使耐药寄生虫获得生存和繁殖优势，并有利于其宿主的快速扩张。为了支持这一点，我们还提出流行病学证据表明，在流行地区，携带配子体的恶性疟原虫患者的比例显着增加，因为氯喹耐药性的出现。这些发现与恶性疟原虫对CQ仅部分耐药的国家的耐药性管理和疟疾控制有关。
This paper reports on the features of recrudescent infections of chloroquine-resistant Plasmodium falciparum (CQRPf) malaria from a study in vivo of patients from a malaria endemic (n = 527) and non-endemic (n = 129) region of Sri Lanka where the incidence of RI resistance was 30% and 55%, respectively. In both groups of patients, the recrudescent infections which emerged after treatment of the primary infection with chloroquine (CQ) and primaquine had significantly lower peripheral parasitaemia (0.036% and 0.108% in endemic and non-endemic patients, respectively) compared to their primary infections (mean parasitaemia 0.13% and 0.49%; P = 0.021 and 0.002, respectively). The recrudescences of CQ resistant infections also gave rise to clinical disease of markedly reduced severity (average clinical scores of 10.1 and 8.2) compared to their primary infections (average clinical scores of 12.4 and 12.3; P = 0.003 and 0.001, respectively, in endemic and non-endemic patients). CQ resistant recrudescent infections therefore had a lower probability of being diagnosed and treated. In endemic patients, a higher proportion of CQRPf infections (57%) had gametocytaemia compared to the chloroquine sensitive ones (29%) (P = 0.014 chi(2) = 5.96) and were significantly more infective to mosquitoes (P = 0.047). These findings imply that, in areas where CQ resistance is prevalent, the continued use of the drug may confer a survival and propagation advantage on resistant parasites and favour the rapid expansion of their reservoir. In support of this, we also present epidemiological evidence showing that, in endemic areas, the proportion of P. falciparum patients carrying gametocytes has increased significantly since the emergence of chloroquine resistance. These findings are relevant to the management of drug resistance and malaria control in countries where P. falciparum is only partially resistant to CQ.