Randomized Controlled Trial of Levamisole Hydrochloride as Adjunctive Therapy in Severe Falciparum Malaria With High Parasitemia
Randomized Controlled Trial of Levamisole Hydrochloride as Adjunctive Therapy in Severe Falciparum Malaria With High Parasitemia
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DOI：
10.1093/infdis/jit410
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发表时间：
2014-01-01
影响因子：
6.4
通讯作者：
Dondorp, Arjen M.
中科院分区：
文献类型：
--
作者：
Maude, Richard J.;Silamut, Kamolrat;Dondorp, Arjen M.
背景资料。含有成熟期恶性疟原虫的红细胞的细胞黏附和隔离是严重疟疾发病机制的核心。口服驱虫药左旋咪唑在体外抑制细胞黏附，减少奎宁治疗的无并发症恶性疟疾晚期寄生虫的隔离。结果，孟加拉一家转诊医院收治的56名患有严重疟疾和高寄生虫血症的成年患者被随机分成两组，一组接受单剂量盐酸左旋咪唑(150毫克)治疗，另一组不接受青蒿琥酯静脉注射辅助抗疟治疗。左旋咪唑组晚期循环寄生虫清除曲线下的中位数面积为2150个寄生虫/亩L x小时，对照组为5489个寄生虫/亩L x小时(P=0.25)。所有寄生虫期的6小时和12小时的“隔离比率”和微血管血流的变化在治疗组之间没有差别(所有P>；.40)。血浆乳酸恢复正常的中位数时间(
Background. Cytoadherence and sequestration of erythrocytes containing mature stages of Plasmodium falciparum are central to the pathogenesis of severe malaria. The oral anthelminthic drug levamisole inhibits cythadherence in vitro and reduces sequestration of late-stage parasites in uncomplicated falciparum malaria treated with quinine.Methods. Fifty-six adult patients with severe malaria and high parasitemia admitted to a referral hospital in Bangladesh were randomized to receive a single dose of levamisole hydrochloride (150 mg) or no adjuvant to antimalarial treatment with intravenous artesunale,Results. Circulating late-stage parasites measured as the median area under the parasite clearance curves were 2150 (interquartile range [IQR], 0-28 025) parasites/mu L x hour in patients treated with levamisole and 5489 (IQR, 192-25 848) parasites/mu L, x hour in controls (P =.25). The "sequestration ratios" at 6 and 12 hours for all parasite stages and changes in microvascular blood flow did not differ between treatment groups (all P>.40). The median time to normalization of plasma lactate (