Plasmodium vivax recurrence following falciparum and mixed species malaria: risk factors and effect of antimalarial kinetics.
Plasmodium vivax recurrence following falciparum and mixed species malaria: risk factors and effect of antimalarial kinetics.
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DOI：
10.1093/cid/ciq249
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发表时间：
2011-03-01
期刊：
影响因子：
--
通讯作者：
Price RN
中科院分区：
文献类型：
--
作者：
Douglas NM;Nosten F;Ashley EA;Phaiphun L;van Vugt M;Singhasivanon P;White NJ;Price RN
在泰缅边境，间日疟原虫是急性恶性疟疾治疗后寄生虫学失败的最常见原因。缓慢消除抗疟药物可显著降低早期复发的风险。(See贝尔德的社论，在第页上。）背景在共同流行的地区，间日疟原虫疟疾通常在恶性疟疾治疗后发生。这是可预防疾病的一个重要原因。方法.我们在1991年至2005年在泰缅边境进行的一系列临床试验中，研究了导致急性恶性疟疾治疗后间日疟原虫感染复发风险的因素。结果总体而言，10，549名患者（4，960名年龄<15岁的儿童和5，589名成人）接受了恶性疟治疗;根据筛选时进行的显微镜检查，这些患者中，9，385名（89.0%）患有恶性疟原虫单一感染，1，164名（11.0%）患有恶性疟原虫/间日疟原虫混合感染。到第63天恶性疟原虫感染复发的累积比例为21.5%（95%置信区间[CI]，20.3%-22.8%），间日疟原虫感染复发的累积比例为31.5%（95% CI，30.1%-33.0%）。间日疟原虫感染复发的重要危险因素是入组时的混合感染、男性、年龄较小、血细胞比容较低、无性恶性疟原虫寄生虫密度较高（所有因素P < .001）和入组时的恶性疟原虫配子体血症（P = .001）。到第63天，恶性疟原虫单次感染后发生间日疟的累积风险为51.1%（95% CI，46.1%-56.2%）（t1/2 <1天），35.3%中间半衰期药物治疗后（95% CI，31.8%-39.0%）（t1/2 1-7天）和19.6%（95%CI，18.1%-21.3%）在缓慢消除药物治疗后（t1/2 > 7天）（P < .001，通过趋势检验）。与蒿甲醚-苯芴醇和青蒿琥酯-阿托伐醌-氯胍复方制剂相比，含有甲氟喹或哌喹的青蒿素复方制剂与单纯或混合恶性疟原虫感染后63天内间日疟原虫感染复发的校正风险比降低3.6倍至4.2倍相关（与青蒿琥酯-甲氟喹相比，P <0.001）。结论.在泰缅边境，间日疟原虫是恶性疟疾治疗后寄生虫学失败的最常见原因。缓慢消除抗疟药可降低间日疟原虫感染早期复发的风险。
On the Thai-Myanmar border, Plasmodium vivax is the most common cause of parasitological failure following treatment for acute falciparum malaria. Slowly eliminated antimalarials significantly reduce the risk of early recurrence. (See editorial commentary by Baird, on pages .) Background. Plasmodium vivax malaria commonly follows treatment of falciparum malaria in regions of co-endemicity. This is an important cause of preventable morbidity. Methods. We examined the factors contributing to the risk of recurrence of P. vivax infection after treatment of acute falciparum malaria in a series of clinical trials conducted on the Thai-Myanmar border from 1991 through 2005. Results. Overall, 10,549 patients (4960 children aged <15 years and 5589 adults) were treated for falciparum malaria; of these patients, 9385 (89.0%) had Plasmodium falciparum monoinfection and 1164 (11.0%) had mixed P. falciparum/P. vivax infections according to microscopic examinations performed at screening. The cumulative proportion of patients with P. falciparum infection recurrence by day 63 was 21.5% (95% confidence interval [CI], 20.3%–22.8%), and the cumulative proportion with P. vivax infection recurrence was 31.5% (95% CI, 30.1%–33.0%). Significant risk factors for P. vivax infection recurrence were mixed infection at enrollment, male sex, younger age, lower hematocrit, higher asexual P. falciparum parasite density (P < .001 for all factors), and P. falciparum gametocytemia at enrollment (P = .001). By day 63, the cumulative risk of vivax malaria after P. falciparum monoinfection was 51.1% (95% CI, 46.1%–56.2%) after treatment with rapidly eliminated drugs (t1/2 <1 day), 35.3% (95% CI, 31.8%–39.0%) after treatment with intermediate half-life drugs (t1/2 1–7 days), and 19.6% (95% CI, 18.1%–21.3%) after treatment with slowly eliminated drugs (t1/2 > 7 days) (P < .001, by test for trend). Artemisinin-based combinations containing mefloquine or piperaquine, compared with the artemether-lumefantrine and artesunate-atovaquone-proguanil combinations, were associated with a 3.6-fold to 4.2-fold lower adjusted hazard ratio for P. vivax infection recurrence within 63 days after pure or mixed P. falciparum infections (P < .001, for comparisons with artesunate-mefloquine). Conclusions. On the Thai-Myanmar border, P. vivax is the most common cause of parasitological failure after treatment for falciparum malaria. Slowly eliminated antimalarials reduce the risk of early P. vivax infection recurrence.
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DOI：
10.4269/ajtmh.1998.59.883
发表时间：
1998-12-01
影响因子：
3.3
作者：
Price, R;Van Vugt, M;White, N
通讯作者：
White, N
影响因子：
6.4
作者：
Ashley, EA;Krudsood, S;White, NJ
通讯作者：
White, NJ
DOI：
10.1016/0035-9203(95)90094-2
发表时间：
1995-09-01
影响因子：
2.2
作者：
PRICE, RN;NOSTEN, F;WHITE, NJ
通讯作者：
WHITE, NJ
影响因子：
2
作者：
Glidden, DV;Vittinghoff, E
通讯作者：
Vittinghoff, E
影响因子：
158.5
作者：
Karunajeewa, Harin A.;Mueller, Ivo;Davis, Timothy M. E.
通讯作者：
Davis, Timothy M. E.