Plasmodium malaria resistant to chloroquine in a Zambian living in Zambia.

Abstract

1315We are grateful to Dr J Stevenson and Dr E C Gordon Smith for allowing us to report this case.'Perillo RP, Pohl DA, Roodman ST, Tsai CC. Acute non A non B hepatitis with serum sickness-like syndrome and aplastic anaemia. JAMA 1981 ;245:494-6 Conversiotn: SI to traditional iuits-viscosity of plasma and whole blood: I mPa s I cP.30"', increase in fetal blood viscosity, this rise being compounded of a 120%increase in packed cell volume and an 18% fall in erythrocyte deformability.Neither plasma viscosity nor plasma fibrinogen values were altered. The mean birth weight was 318 g lower in infants born to smoking mothers. CommentMaternal cigarette smoking in pregnancy results in changes in fetal blood viscosity and its major determinants similar to those described in non-pregnant adult smokers.3 When adult smokers become pregnant the large physiological variations in blood viscosity factors obscure the effects of smoking in maternal blood5 but not so in the fetus. In the extensive capillary microcirculation of the fetal placental villi, raised blood viscosity and reduced erythrocyte deformability would be apt to reduce blood flow significantly in accordance with Poiseuille's law. Reduced intravillous perfusion would combine with reduced intervillous blood flow on the maternal side of the placenta, owing to the effects of nicotine, and with the already reduced oxygen availability in both maternal and fetal blood, to cause fetal hypoxia stimulating fetal erythropoiesis with a further increase in blood viscosity leading to a vicious circle of decreasing flow and further hypoxia. This study indicates a new pathogenic pathway for the deleterious effects of maternal cigarette smoking on fetal growth and development in pregnancy. Recently, chloroquine resistant Plasmodium falciparum has been acquired in east Africa by white visitors.' 2 We have carried out more than 25 successful in vitro macrotests, 15 in vitro microtests using capillary blood specimens, and 130 in vivo tests on the susceptibility of P falciparum in Zambia to chloroquine and to the new antimalarial drug mefloquine.3-5 In the in vivo tests the patients were observed in an environment free of mosquitoes for 28-63 days after they developed malaria. Our results showed that P falciparum in Zambia is generally sensitive to standard doses of chloroquine or mefloquine.Here, however, we report perhaps the first proved case of chloroquine resistant Pfalciparum in an African living in Africa.Case report A 26 year old Zambian staff nurse developed clinical malaria, which was confirmed microscopically to be due to asexual P falciparum, one month after she had moved to a village 1000 km north east of Ndola. She was treated on 10 June 1982 with two doses of 200 mg chloroquine intramuscularly at an interval of eight hours. She refused a further injection of chloroquine the next day and instead took 600 mg amodiaquine by mouth. Her clinical condition improved for four days, during which time she returned to Ndola. For the next 10 days she felt slightly unwell with feve...

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