Relapsing Malaria: A Case Report of Primaquine Resistance
Relapsing Malaria: A Case Report of Primaquine Resistance
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DOI：
10.1155/2018/9720823
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发表时间：
2018-01-01
影响因子：
1.1
通讯作者：
Fabbri, Marilyn
中科院分区：
文献类型：
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作者：
Dijanic, Christopher;Nickerson, Jillian;Fabbri, Marilyn
伯氨喹（一种8-氨基喹啉疟疾治疗药物）是fda批准的唯一治疗间日疟原虫催眠子期的药物。我们认为复发是由于寄生虫耐药性或药物毒性引起的依从性差。然而，在反复治疗失败的患者中，我们必须考虑到影响药物代谢的cyp450突变是复发的重要原因。2015年7月，一名前往委内瑞拉丛林的47岁男子被诊断患有恶性疟原虫和间日疟原虫。在接下来的一年里，他接受了7轮以伯氨喹为基础的治疗，所有这些治疗都导致复发，而没有进一步暴露于流行地区。在他的第八次报告中，他被发现有CYP-4502D6突变，影响伯氨喹的代谢和激活。此后，他的治疗没有复发。伯氨喹的疗效取决于许多因素。了解导致疟疾复发的机制对于成功治疗和降低发病率和死亡率至关重要。这个病例说明了在疟疾复发病例中考虑影响药物疗效的细胞色素突变的重要性。
Primaquine (an 8-aminoquinoline malarial therapy) is the only FDA-approved therapy to treat the hypnozoite stage of P. vivax. We think of relapse occurring because of parasitic resistance or poor compliance secondary to drug toxicities. However, in patients with repeated treatment failure, we must consider CYP-450 mutations affecting drug metabolism as an important cause of relapse. A 47-year-old man who travelled to a jungle in Venezuela was diagnosed with P. falciparum and P. vivax in July 2015. He was treated with seven rounds of primaquine-based therapy in the following year, all resulted in relapse without further exposure to endemic areas. On his eighth presentation, he was found to have CYP-4502D6 mutation that affected the metabolism and activation of primaquine. Thereafter, he was treated without relapse. Primaquine efficacy depends on many factors. Understanding the mechanism responsible for malaria relapse is paramount for successful treatment and reduction in morbidity and mortality. This case illustrates the importance of considering cytochrome mutations that affect drug efficacy in cases of relapsing malaria.