Abstract:Resumo Relata-se a ocorrência de resistência à mefloquina administrada na dose de 20mg/kg em 51 crianças com malária falciparum atendidas em centro de referência em Manaus, Brasil, no período de outubro a novembro de 1997. Todas as crianças foram avaliadas nos dias 3, 5, 7, 14, 21, 28 e 35 do tratamento, segundo critérios clínico e parasitológico. Foi encontrada uma incidência de resistência RIII de 5,9% (IC 95% variando de 1,5 a 17,2), a razão cura/resistência calculada foi 20:1 e cura/gravidade 62:1. Os dado… Show more
“…Before artemisinin-based combination therapies (ACTs) were approved worldwide as first-line therapy for uncomplicated falciparum malaria in 2007, chloroquine (CQ) was widely used in Brazil, especially up to the 1980s, to treat acute infections with P. falciparum as a safe, inexpensive, and effective antimalarial drug [ 7 , 8 , 9 ]. Mefloquine was then introduced as a therapeutic alternative for multidrug-resistant falciparum malaria; it was used until the introduction of ACTs in Brazil, with relative safety, alone or in association with artemisinin derivatives in cases of severe malaria and multidrug-resistant P. falciparum parasites [ 10 ]. Currently, after reports of cases of resistance to mefloquine [ 10 ], this drug is only used in combination with artesunate for the treatment of acute, uncomplicated malaria caused by P. falciparum .…”
Section: Introductionmentioning
confidence: 99%
“…Mefloquine was then introduced as a therapeutic alternative for multidrug-resistant falciparum malaria; it was used until the introduction of ACTs in Brazil, with relative safety, alone or in association with artemisinin derivatives in cases of severe malaria and multidrug-resistant P. falciparum parasites [ 10 ]. Currently, after reports of cases of resistance to mefloquine [ 10 ], this drug is only used in combination with artesunate for the treatment of acute, uncomplicated malaria caused by P. falciparum . It is indicated for cases of P. falciparum mono-infection, as well as for mixed infections with P. vivax (with subsequent treatment of its hypnozoite forms).…”
(1) Background: Malaria is a public health problem worldwide. Despite global efforts to control it, antimalarial drug resistance remains a great challenge. In 2009, our team identified, for the first time in Brazil, chloroquine (CQ)-susceptible Plasmodium falciparum parasites in isolates from the Brazilian Amazon. The present study extends those observations to include survey samples from 2010 to 2018 from the Amazonas and Acre states for the purpose of tracking pfcrt molecular changes in P. falciparum parasites. (2) Objective: to investigate SNPs in the P. falciparum gene associated with chemoresistance to CQ (pfcrt). (3) Methods: Sixty-six P. falciparum samples from the Amazonas and Acre states were collected from 2010 to 2018 in patients diagnosed at the Reference Research Center for Treatment and Diagnosis of Malaria (CPD-Mal/Fiocruz), FMT-HVD and Acre Health Units. These samples were subjected to PCR and DNA Sanger sequencing to identify mutations in pfcrt (C72S, M74I, N75E, and K76T). (4) Results: Of the 66 P. falciparum samples genotyped for pfcrt, 94% carried CQ-resistant genotypes and only 4 showed a CQ pfcrt sensitive-wild type genotype, i.e., 1 from Barcelos and 3 from Manaus. (5) Conclusion: CQ-resistant P. falciparum populations are fixed, and thus, CQ cannot be reintroduced in malaria falciparum therapy.
“…Before artemisinin-based combination therapies (ACTs) were approved worldwide as first-line therapy for uncomplicated falciparum malaria in 2007, chloroquine (CQ) was widely used in Brazil, especially up to the 1980s, to treat acute infections with P. falciparum as a safe, inexpensive, and effective antimalarial drug [ 7 , 8 , 9 ]. Mefloquine was then introduced as a therapeutic alternative for multidrug-resistant falciparum malaria; it was used until the introduction of ACTs in Brazil, with relative safety, alone or in association with artemisinin derivatives in cases of severe malaria and multidrug-resistant P. falciparum parasites [ 10 ]. Currently, after reports of cases of resistance to mefloquine [ 10 ], this drug is only used in combination with artesunate for the treatment of acute, uncomplicated malaria caused by P. falciparum .…”
Section: Introductionmentioning
confidence: 99%
“…Mefloquine was then introduced as a therapeutic alternative for multidrug-resistant falciparum malaria; it was used until the introduction of ACTs in Brazil, with relative safety, alone or in association with artemisinin derivatives in cases of severe malaria and multidrug-resistant P. falciparum parasites [ 10 ]. Currently, after reports of cases of resistance to mefloquine [ 10 ], this drug is only used in combination with artesunate for the treatment of acute, uncomplicated malaria caused by P. falciparum . It is indicated for cases of P. falciparum mono-infection, as well as for mixed infections with P. vivax (with subsequent treatment of its hypnozoite forms).…”
(1) Background: Malaria is a public health problem worldwide. Despite global efforts to control it, antimalarial drug resistance remains a great challenge. In 2009, our team identified, for the first time in Brazil, chloroquine (CQ)-susceptible Plasmodium falciparum parasites in isolates from the Brazilian Amazon. The present study extends those observations to include survey samples from 2010 to 2018 from the Amazonas and Acre states for the purpose of tracking pfcrt molecular changes in P. falciparum parasites. (2) Objective: to investigate SNPs in the P. falciparum gene associated with chemoresistance to CQ (pfcrt). (3) Methods: Sixty-six P. falciparum samples from the Amazonas and Acre states were collected from 2010 to 2018 in patients diagnosed at the Reference Research Center for Treatment and Diagnosis of Malaria (CPD-Mal/Fiocruz), FMT-HVD and Acre Health Units. These samples were subjected to PCR and DNA Sanger sequencing to identify mutations in pfcrt (C72S, M74I, N75E, and K76T). (4) Results: Of the 66 P. falciparum samples genotyped for pfcrt, 94% carried CQ-resistant genotypes and only 4 showed a CQ pfcrt sensitive-wild type genotype, i.e., 1 from Barcelos and 3 from Manaus. (5) Conclusion: CQ-resistant P. falciparum populations are fixed, and thus, CQ cannot be reintroduced in malaria falciparum therapy.
“…O tratamento apresenta complexidade -diferentes medicamentos em diferentes regimes terapêuticos e duração variável. Além disso, a demora e a pouca precisão diagnóstica, o emprego de terapêutica inapropriada e o uso indiscriminado de antimaláricos também contribuem para a alta incidência da malária e desenvolvimento de resistência 4,9,10 .…”
A malária é a endemia parasitária mais importante no mundo. No Brasil, 60% do território são favoráveis à transmissão, com cerca de 500 mil casos por ano. A doença não se distribui geograficamente de forma homogênea, fato que pode explicar diferenças na eficácia e efetividade dos tratamentos. Para identificar as evidências que poderiam ter embasado os tratamentos recomendados pelo Manual de Terapêutica da Malária 2001, foi realizada uma revisão dos estudos que abordassem tratamentos com antimaláricos no Brasil entre 1980 e 2005. Foram encontrados poucos estudos, e com baixa qualidade metodológica, nenhum deles capaz de gerar recomendações para protocolos baseados em evidência. Os artigos publicados após 2001 apresentaram nível de evidência maior, segundo classificação utilizada para definição de níveis de evidência farmacológico-clínicos. Espera-se que tais estudos também orientem conduta na próxima revisão do manual, prevista para o ano de 2007. Constatou-se que as referências do manual, utilizadas como base para recomendação dos tratamentos, são publicações desatualizadas e possivelmente consideradas clássicas, mas com pouca especificidade para região geográfica, população e/ou tipo de malária.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.