Efficacy in the treatment of malaria by Plasmodium vivax in Oiapoque, Brazil, on the border with French Guiana: the importance of control over external factors

Malaria Journal

Research

Vanja S. C. D`Almeida Couto¹  Rubens A. O. Menezes²  Aldo A. P. Júnior³  Margarete do Socorro M. Gomes⁴  Ana P. M. Sousa⁵  José Luiz F. Vieira⁶  Álvaro A. R. D’Almeida Couto⁶  Eric Legrand⁷  Lise Musset⁷  Mathieu Nacher⁸  Aurélia Stefani⁹  Ricardo L. D. Machado^1,10 

[1] Amapá State Health Department (Secretaria de Estado da Saúde do Amapá – SESA), Macapá, Amapá, Brazil;Central Laboratory of Public Health of Amapá (Laboratório Central de Saúde Pública do Amapá - LACEN-AP), Macapá, Amapá, Brazil;Central Laboratory of Public Health of Amapá (Laboratório Central de Saúde Pública do Amapá - LACEN-AP), Macapá, Amapá, Brazil;Federal University of Amapá (Universidade Federal do Amapá - UNIFAP), Macapá, Amapá, Brazil;Central Laboratory of Public Health of Amapá (Laboratório Central de Saúde Pública do Amapá - LACEN-AP), Macapá, Amapá, Brazil;Federal University of Pará (Universidade Federal do Pará - UFPA), Belém, Pará, Brazil;Federal University of Amapá (Universidade Federal do Amapá - UNIFAP), Macapá, Amapá, Brazil;Federal University of Pará (Universidade Federal do Pará - UFPA), Belém, Pará, Brazil;Institut Pasteur de la Guyane, Cayenne, French Guiana;Université des Antilles et de la Guyane, Cayenne, French Guiana;Centre d’Investigation Clinique – Epidémiologie Clinique Antilles-Guyane (CIC-EC INSERM CIE 802), Cayenne General Hospital, Cayenne, French Guiana;Université des Antilles et de la Guyane, Cayenne, French Guiana;Institut Pasteur de la Guyane, Cayenne, French Guiana;‘Evandro Chagas’ Institute (Instituto Evandro Chagas), Belém, Pará, Brazil;

关键词: Malaria;    Plasmodium vivax;    Anti-malarials;    Treatment efficacy;    Brazil-French Guiana border;    External factors;    Treatment failure;   

DOI  :  10.1186/s12936-015-0925-7

 received in 2015-07-20, accepted in 2015-09-28,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPlasmodium vivax malaria is an important public health issue in the Amazon region, and it accounts for approximately 84 % of cases of the disease. Migration across the border between Brazil and French Guiana contributes to the maintenance of the disease. The aim of this study was to evaluate the therapeutic and parasitological responses of patients with P. vivax malaria treated with chloroquine and primaquine in the socio-environmental context of cross-border interactions between Brazil and French Guiana. The factors controlled were diagnostic agreement, adherence, adjustment of primaquine doses for patient weight, and quality of the drugs used.MethodsA prospective study was conducted in 2011 with 103 individuals aged 10–60 years with a positive diagnosis of P. vivax treated with chloroquine (10 mg base/kg on the first day, followed by 7.5 mg/kg on the second and third days) and primaquine for 7 days, who were followed for 28 days. The primaquine doses were adjusted for the patients’ weight. A number of factors were determined: epidemiological characteristics, origin of patients, signs and symptoms, initial parasitaemia and parasitaemia clearance time, blood concentrations of chloroquine and primaquine, quality of anti-malarial drugs and diagnostic agreement.ResultsNinety-five patients were followed for 28 days. There was a 100 % agreement in microscopic diagnosis between field laboratory and reference centre. The adhesion to the treatment was 100 %. Of these patients, 32.6 % received a weight-adjusted dose of primaquine. The chloroquine and primaquine tablets were consistent with the optimal quality limits for human consumption. The investigated patients achieved optimal blood exposure to anti-malarial drugs. The parasitological and therapeutic response was adequate in 99.0 % of cases.ConclusionsIn the municipality of Oiapoque, the therapeutic regime used for the treatment of P. vivax malaria using chloroquine combined with primaquine remains effective, when external factors are controlled, such as the quality of anti-malarial drugs, the adhesion to the treatment prescribed, the correct diagnostic and the adjustment of primaquine dose for patient body weight.

【 授权许可】

CC BY   
© Gomes et al. 2015