Recurrence of Plasmodium malariae and P. falciparum Following Treatment of Uncomplicated Malaria in North Sumatera With Dihydroartemisinin-Piperaquine or Artemether-Lumefantrine.

Autor: Lubis IND; Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.; Infection and Immunity Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom., Wijaya H; Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia., Lubis M; Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia., Lubis CP; Department of Paediatrics, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia., Beshir KB; Infection and Immunity Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom., Staedke SG; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom., Sutherland CJ; Infection and Immunity Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.; PHE Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2020 Apr 02; Vol. 7 (5), pp. ofaa116. Date of Electronic Publication: 2020 Apr 02 (Print Publication: 2020).
DOI: 10.1093/ofid/ofaa116
Abstrakt: Background: We assessed the efficacy of artemisinin-based combination therapies for treatment of uncomplicated falciparum malaria, with or without co-infecting Plasmodium spp., in Sumatera, Indonesia.
Methods: Febrile patients aged >6 months with uncomplicated P. falciparum were randomized to receive dihydroartemisinin-piperaquine or artemether-lumefantrine, plus single-dose primaquine, and were followed for 42 days. Mixed Plasmodium infections were included; P. vivax infections received 14 days of primaquine. We retrospectively restricted the analysis to cases with polymerase chain reaction (PCR)-confirmed parasitemia. Recurrent parasitemia in follow-up was identified by species-specific nested PCR.
Results: Of the 3731 participants screened, 302 were enrolled and randomized. In the dihydroartemisinin-piperaquine arm, P. falciparum infections were confirmed by PCR in 59 participants, with mixed infections in 23 (39.0%). In the artemether-lumefantrine arm, P. falciparum infections were confirmed by PCR in 55 participants, with mixed infections in 16 (29.0%). Both regimens were well tolerated, and symptoms improved rapidly in all treated participants. In the dihydroartemisinin-piperaquine arm, 1 P. falciparum recurrence (on day 7) and 6 P. malariae recurrences (1 had a mixed infection with P. falciparum ) were identified during days 3-42 of follow-up. In the artemether-lumefantrine arm, 1 P. falciparum/P. malariae/P. vivax recurrence occurred on day 35. Submicroscopic persistence occurred during follow-up in 21 (37%) of 57 receiving dihydroartemisinin-piperaquine and 20 (39%) of 51 receiving artemether-lumefantrine.
Conclusions: In Sumatera, both regimens effectively cleared initial parasitemia, but P. falciparum and P. malariae persisted in some individuals. Molecular species detection should be deployed in antimalarial efficacy trials in Indonesia.
Trial Registration: NCT02325180.
(© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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