Recrudescence of Plasmodium malariae after Quinine
Recrudescence of Plasmodium malariae after Quinine
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DOI：
10.1155/2014/590265
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发表时间：
2014-01-01
影响因子：
0.8
通讯作者：
Assallum, Hussein
中科院分区：
文献类型：
--
作者：
Kugasia, Irfanali R.;Polara, Farhana K.;Assallum, Hussein
疟疾引起罕见的良性疟疾，发现于疟疾流行地区，主要是撒哈拉以南非洲。由于疟疾在人类体内没有持续的肝脏阶段，因此再次感染而不再暴露的唯一方法是通过复发。然而，关于它在抗疟疾药物治疗后复发的报道很少，文献中只有少数病例报告。到目前为止，这一领域的研究还不能确定疟原虫对常用抗疟疾药物出现了耐药性。在本病例中，患者在用奎宁和克林霉素完全治疗后，疟疾复发。用全程氯喹治疗复发，治疗后立即清除血液中的寄生虫，并进行两个月的随访。这种情况的复发不能用以前文章中解释的机制来解释。我们认为，血液中一些疟疾滋养体的惰性可以保护它们免受抗疟药毒性作用的影响，并使它们能够在以后复发。然而，当复发时，这不应被认为是耐药的情况，应考虑一个疗程的氯喹。
Plasmodium malariae causes uncommon benign malaria found in the malaria endemic regions mostly of Sub-Saharan Africa. As Plasmodium malariae does not have a continued liver stage in humans the only way to have reinfection without reexposure is through recrudescence. However, reports of its recrudescence after antimalarials are rare with only a handful of case reports in the literature. Research in this field to date has not been able to establish definitively an emergence of resistance in Plasmodiummalariae to commonly used antimalarials. In the presented case, patient had a recrudescence of P.malariae after full treatment with quinine and clindamycin. This recrudescence was treated with full course of chloroquine with clearance of parasite from blood immediately after treatment and at twomonths' follow up. The recrudescence in this case cannot be explained bymechanisms explained in prior articles. We propose that the indolence of some of the Plasmodium malariae trophozoites in the blood can shield them from the effect of the toxic effects of antimalarials and enable them to produce recrudescence later. However, when recrudescence happens, this should not be considered a case of development of resistance and a course of chloroquine should be considered.