Malária por Plasmodium falciparum. Análise quadrienal, durante 12 anos, da eficácia do tratamento com quinino

Abstract

The efficacy of quinine for the treatment of falciparum malaria was studied by quadriennal analysis of the medical records of 454 patients admitted to the HDT-GO from 1983 to 1994 and treated with identical doses of quinine alone for 7 days. In the quadriennium from 1983 to 1986, 98.4% of the patients became negative by the 5th day of treatment and 8% presented recurrence (R1); from 1987 to 1990, only 72.9% became negative by the 5th day of treatment, 1.4% remained positive until the 7th day (R2) and 9.7% presented recurrence (R1); from 1991 to 1994, 70.1% became negative by the 5th day of treatment, 3.5% remained positive until the 7th day (R2) and 20% presented recurrence (R1). The increase in parasite clearance time with failure up to the 7th day of treatment (R2) and the increase in recurrence (R1) show that P. falciparum is developing resistance to quinine in the region under study.

In vitro evaluation of quinidine sensitivity in brazilian Plasmodium falciparum isolates: comparative analysis to quinine and chloroquine

“…Nevertheless, decreasing in P. falciparum susceptibility to quinine was confirmed, in particular, with Isolate 1 (the highest IC 50 ) and with Isolates 5 and 6, collected for a long time and much more sensitive to quinine. These data corroborated recent evaluations 16,26,41 , showing a unquestionable and worryingly loss of quinine effectiveness in Brazilian strains. Interestingly, quinine was more case, the parasitemia rate of quinine was smaller than the quinidine and the difference increases with the concentration.…”

“…Then, tetracycline began to be co-administered with quinine in order to overcome the resistance problem and to reduce its inherent toxicity 2,8,9 . Quinine is still considered a useful drug for treating non-complicated falciparum malaria 8 . Nevertheless, a gradual increase in the time to clear the parasitemia followed by an elevation in recurrence frequency were observed in patients from the Eastern Amazon, where quinine was employed during the quadriennial 1983-1994 26 . Moreover, decrease in quinine sensitivity was also evidenced in two recent reports performed with Brazilian samples from Mato Grosso State, Amazon area 16,41 .…”

“…With the purpose of facing the challenge of quinine effectiveness decrease in Brazilian P. falciparum strains 1,2,8,9,16,26,34,41 , we evaluated the in vitro sensitivity of isolates from North Brazilian States to quinidine in comparison to quinine and chloroquine. We were based on previous studies when quinidine showed to exert antimalarial effect in concentrations many times inferior than those used in the cardiovascular therapy 23 .…”

Antimalarial Activity of the Novel Quinoline/6‐Thiopurine Conjugate in Gallus gallus Linnaeus, Infected Experimentally by Plasmodium (Novyella) juxtanucleare

“…Parasite resistance to sulfadoxine–pyrimethamine and, with more recent drugs, such as mefloquine and halofantrine, has also occurred. Works regarding the treatment of P. falciparum infection with quinine show decreasing levels of sensitivity (14).…”

Estudo dos mecanismos imunológicos envolvidos na recrudescência da malária experimental durante a gravidez.

“…Situações de recaída após vários anos podem ser observadas em indivíduos infectados por P. vivax e P. ovale, neste caso, devido a presença de hipnozoítos no fígado (ANSTEY et al, 2009). Além disso, o P. falciparum também pode persistir após a infecção inicial e sem parasitemia periférica aparente (PINELI et al, 1999), sugerindo que outras células, que não os hepatócitos, podem abrigar os eritrócitos parasitados, evitando assim que estes sejam eliminados pelo sistema imune.…”