Carriage of chloroquine-resistant parasites and delay of effective treatment increase the risk of severe malaria in Gambian children
Carriage of chloroquine-resistant parasites and delay of effective treatment increase the risk of severe malaria in Gambian children
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DOI：
10.1086/496887
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发表时间：
2005-11-01
影响因子：
6.4
通讯作者：
Sutherland, CJ
中科院分区：
文献类型：
--
作者：
Meerman, L;Ord, R;Sutherland, CJ
234名冈比亚儿童严重恶性疟疾谁被收进儿科病房的农村地区医院，每个年龄匹配的同性对照组作为门诊与单纯恶性疟疾。严重疟疾性贫血（SMA）是最常见的表现（152例），其次是脑型疟疾（38例）和高寄生虫血症（26例）。与其他严重表现的儿童相比，SMA表现的儿童明显更年轻，更容易携带配子体。与氯喹耐药寄生虫相关的基因pfcrt和pfmdr 1等位基因在SMA患者中一起出现的频率高于其匹配的对照组（比值比，2.08 [95%置信区间，1.04 - 4.38]; P = 0.039）。在病例对照分析中，前往医院的费用超过0.20美元、使用驱蚊剂和携带耐药寄生虫被确定为严重疟疾的独立危险因素。我们的结论是，在这种情况下，难以进入医院和高流行率的氯喹耐药寄生虫导致延迟充分治疗的幼儿疟疾，谁可能会发展SMA。
Two hundred thirty-four Gambian children with severe falciparum malaria who were admitted to the pediatric ward of a rural district hospital each were matched for age with a same-sex control subject presenting as an outpatient with uncomplicated falciparum malaria. Severe malarial anemia (SMA) was the most common presentation ( 152 cases), followed by cerebral malaria ( 38 cases) and hyperparasitemia ( 26 cases). Children presenting with SMA were significantly younger and more likely to carry gametocytes than were children with other severe presentations. Alleles of the genes pfcrt and pfmdr1 associated with chloroquine-resistant parasites occurred together among cases presenting with SMA alone more often than among their matched controls (odds ratio, 2.08 [95% confidence interval, 1.04 - 4.38]; P = .039). Costs of travel to the hospital of more than US $0.20, use of mosquito repellents, and carriage of resistant parasites were identified as independent risk factors for severe malaria in the case-control analysis. We conclude that, in this setting, poor access to the hospital and a high prevalence of chloroquine-resistant parasites lead to a delay of adequate treatment for young children with malaria, who may then develop SMA.