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      Chloroquine resistant vivax malaria in a pregnant woman on the western border of Thailand

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          Abstract

          Chloroquine (CQ) resistant vivax malaria is spreading. In this case, Plasmodium vivax infections during pregnancy and in the postpartum period were not satisfactorily cleared by CQ, despite adequate drug concentrations. A growth restricted infant was delivered. Poor susceptibility to CQ was confirmed in-vitro and molecular genotyping was strongly suggestive of true recrudescence of P. vivax. This is the first clinically and laboratory confirmed case of two high-grade CQ resistant vivax parasite strains from Thailand.

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          High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction.

          G Snounou, S Viriyakosol, X Zhu … (1993)
          Article 0 comments Cited 422 times – based on 0 reviews     Review now
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            Relapses of Plasmodium vivax infection usually result from activation of heterologous hypnozoites.

            Mallika Imwong, Georges Snounou, Sasithon Pukrittayakamee … (2007)
            Relapses originating from hypnozoites are characteristic of Plasmodium vivax infections. Thus, reappearance of parasitemia after treatment can result from relapse, recrudescence, or reinfection. It has been assumed that parasites causing relapse would be a subset of the parasites that caused the primary infection. Paired samples were collected before initiation of antimalarial treatment and at recurrence of parasitemia from 149 patients with vivax malaria in Thailand (n=36), where reinfection could be excluded, and during field studies in Myanmar (n=75) and India (n=38). Combined genetic data from 2 genotyping approaches showed that novel P. vivax populations were present in the majority of patients with recurrent infection (107 [72%] of 149 patients overall [78% of patients in Thailand, 75% of patients in Myanmar {Burma}, and 63% of patients in India]). In 61% of the Thai and Burmese patients and in 55% of the Indian patients, the recurrent infections contained none of the parasite genotypes that caused the acute infection. The P. vivax populations emerging from hypnozoites commonly differ from the populations that caused the acute episode. Activation of heterologous hypnozoite populations is the most common cause of first relapse in patients with vivax malaria.
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              Resistance to therapies for infection by Plasmodium vivax.

              J. Baird (2009)
              The gravity of the threat posed by vivax malaria to public health has been poorly appreciated. The widely held misperception of Plasmodium vivax as being relatively infrequent, benign, and easily treated explains its nearly complete neglect across the range of biological and clinical research. Recent evidence suggests a far higher and more-severe disease burden imposed by increasingly drug-resistant parasites. The two frontline therapies against vivax malaria, chloroquine and primaquine, may be failing. Despite 60 years of nearly continuous use of these drugs, their respective mechanisms of activity, resistance, and toxicity remain unknown. Although standardized means of assessing therapeutic efficacy against blood and liver stages have not been developed, this review examines the provisional in vivo, ex vivo, and animal model systems for doing so. The rationale, design, and interpretation of clinical trials of therapies for vivax malaria are discussed in the context of the nuance and ambiguity imposed by the hypnozoite. Fielding new drug therapies against real-world vivax malaria may require a reworking of the strategic framework of drug development, namely, the conception, testing, and evaluation of sets of drugs designed for the cure of both blood and liver asexual stages as well as the sexual blood stages within a single therapeutic regimen.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Malar J
                Title: Malaria Journal
                Publisher: BioMed Central
                ISSN (Electronic): 1475-2875
                Publication date Collection: 2011
                Publication date (Electronic): 5 May 2011
                Volume: 10
                Page: 113
                Affiliations
                [1 ]Shoklo Malaria Research Unit, PO Box 46 Mae Sot, Tak 63110, Thailand
                [2 ]Laboratory of Malaria Immunobiology, Singapore Immunology Network, Biopolis, Agency for Science Technology and Research (A*STAR), Singapore
                [3 ]Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
                [4 ]University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
                [5 ]Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
                [6 ]Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford OX3 7LJ, UK
                [7 ]INSERM UMR S-945, F-75013 Paris, France
                [8 ]Université Pierre & Marie Curie, Faculté de Médecine Pitié-Salpêtrière, F-75013 Paris, France
                Article
                Publisher ID: 1475-2875-10-113
                DOI: 10.1186/1475-2875-10-113
                PMC ID: 3112451
                PubMed ID: 21545737
                SO-VID: d71e4687-697d-4fcd-8358-e3bc470b56dc
                Copyright © Copyright ©2011 Rijken et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 March 2011
                Date accepted : 5 May 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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