Resistência do Plasmodium falciparum ao fansidar, quinina e tetraciclina

Alencar, Fernando Hélio; Ferraroni, José João; Shrimpton, Roger

doi:10.1590/s0034-89101982000500005

Cited by 3 publications

(3 citation statements)

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“…Before the introduction of ACT in 2006 [ 107 ], the first-line regimens for uncomplicated falciparum malaria recommended by the Ministry of Health of Brazil were quinine plus doxycycline (formerly tetracycline) for 7 days or a single dose of mefloquine. Case reports of mefloquine (e.g., [ 108 ]) and quinine–tetracycline [e.g., 109 ] failure in falciparum malaria have been published since then. The few clinical trials that evaluated the therapeutic efficacy of these regimens reported cure rates ranging between 98.9 [ 110 ] and 100 % [ 111 ] for mefloquine, and between 77.3 [ 98 ] and 100 % [ 97 ] for quinine plus tetracycline.…”

Section: Introductionmentioning

confidence: 99%

Challenges for malaria elimination in Brazil

Ferreira

Castro

2016

Malar J

176

238

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Brazil currently contributes 42 % of all malaria cases reported in the Latin America and the Caribbean, a region where major progress towards malaria elimination has been achieved in recent years. In 2014, malaria burden in Brazil (143,910 microscopically confirmed cases and 41 malaria-related deaths) has reached its lowest levels in 35 years, Plasmodium falciparum is highly focal, and the geographic boundary of transmission has considerably shrunk. Transmission in Brazil remains entrenched in the Amazon Basin, which accounts for 99.5 % of the country’s malaria burden. This paper reviews major lessons learned from past and current malaria control policies in Brazil. A comprehensive discussion of the scientific and logistic challenges that may impact malaria elimination efforts in the country is presented in light of the launching of the Plan for Elimination of Malaria in Brazil in November 2015. Challenges for malaria elimination addressed include the high prevalence of symptomless and submicroscopic infections, emerging anti-malarial drug resistance in P. falciparum and Plasmodium vivax and the lack of safe anti-relapse drugs, the largely neglected burden of malaria in pregnancy, the need for better vector control strategies where Anopheles mosquitoes present a highly variable biting behaviour, human movement, the need for effective surveillance and tools to identify foci of infection in areas with low transmission, and the effects of environmental changes and climatic variability in transmission. Control actions launched in Brazil and results to come are likely to influence control programs in other countries in the Americas.

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Section: Introductionmentioning

confidence: 99%

Challenges for malaria elimination in Brazil

Ferreira

Castro

2016

Malar J

176

238

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“…However, resistance to SP was reported in northern Tocantins State soon after its use was implemented [7]. In 1982, resistance to SP was also described in other Brazilian states, such as Rondônia, Pará, Amazonas and Mato Grosso [8, 9]. Subsequently, Boulos et al [10] reported 100% of therapeutic failure to SP in 54 patients, and in the 1980s quinine in combination with tetracycline was introduced as first-line treatment.…”

Section: Introductionmentioning

confidence: 99%

Analysis of polymorphisms in Plasmodium falciparum genes related to drug resistance: a survey over four decades under different treatment policies in Brazil

Inoue

Lopes

Rosário

et al. 2014

Malar J

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BackgroundAnti-malarial resistance in Plasmodium falciparum remains an obstacle for malaria control. Resistance-associated genes were analysed in Brazilian samples over four decades to evaluate the impact of different treatment regimens on the parasite genetic profile.MethodsSamples were collected on filter paper from patients infected in the Amazon region from 1984 to 2011. DNA was extracted with Chelex® 100 and monoinfection confirmed by PCR. SNPs in the pfcrt, pfmdr1, pfdhfr and pfdhps genes were assessed by PCR-RFLP. The pfmdr1 copy number was estimated using real time quantitative PCR with SYBR® Green. Parasite response was assessed ex vivo with seven concentrations of each anti-malarial. Patients were treated according to Brazilian guidelines: quinine plus tetracycline or mefloquine in period 1 and ACT in period 2.ResultsAll 96 samples presented the pfcrt 76T mutant throughout the assessed periods. In addition, all isolates showed ex vivo chloroquine resistance. The pfmdr1 86Y was detected in 1.5% of samples in period 1, and in 25% in period 2. All samples presented the pfmdr1 1246Y. The analysis of pfmdr1 copy number showed amplification in 37.3% in period 1 and in 42% in period 2. Mutations in pfdhfr were shown as follows: 51I in all samples in period 1 and in 81.2% in period 2; 59R in 6.4% in period 2. The pfdhfr 108N and the pfdhps 437G were seen in all samples along time; the pfdhps 540E in 93.7% in period 1 and in 75% in period 2.ConclusionsThe 76T mutation associated to chloroquine resistance is still present in the parasite population, although this anti-malarial was withdrawn from the chemotherapy of P. falciparum in Brazil in the mid-1980s. All isolates assayed ex vivo for chloroquine showed resistant phenotype and 76T. No association was observed between pfmdr1 mutations and resistance to quinine, mefloquine and artemisinin derivatives. Additionally, the pfdhfr 108N mutation was detected in all samples throughout the evaluated periods, demonstrating fixation of the mutant allele in the parasite population. Changes in Brazilian national guidelines for the malaria chemotherapy in the last 27 years yielded a discreet genetic impact in the parasite population.

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“…In the 1960s and 1970s, the highlight was the discussion of the performance of strategies to control this endemic disease in several Country regions 12 , 47 . In the 1980s, with favorable results in the control of malaria, which practically restricted its endemic transmission to the Legal Amazon region, new challenges were highlighted, such as resistance to drugs 3 , 60 and the impact of development projects on the Amazon, due to the risk of reintroducing the disease in regions where it was already controlled 174 . More recently, following the discussion of new challenges for controlling diseases transmitted by vectors, interesting studies have been published on climate change and malaria transmission 184 , 185 .…”

Section: Introductionmentioning

confidence: 99%

Path of infectious diseases in Brazil in the last 50 years: an ongoing challenge

Waldman

Sato

2016

Rev. Saúde Pública

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In this article, we comment on the main features of infectious diseases in Brazil in the last 50 years, highlighting how much of this path Revista de Saúde Pública could portray. From 1967 to 2016, 1,335 articles focusing on infectious diseases were published in Revista de Saúde Pública. Although the proportion of articles on the topic have decreased from about 50.0% to 15.0%, its notability remained and reflected the growing complexity of the research required for its control. It is noteworthy that studies design and analysis strategies progressively became more sophisticated, following the great development of epidemiology in Brazil in the recent decades. Thus, the journal has followed the success of public health interventions that permitted to control or eliminate numerous infectious diseases – which were responsible, in the past, for high rates of morbidity and mortality –, and also followed the reemergence of diseases already controlled and the emergence of until then unknown diseases, with a strong impact on the Brazilian population, establishing a little predictable and very challenging path.

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Resistência do Plasmodium falciparum ao fansidar, quinina e tetraciclina

Cited by 3 publications

References 11 publications

Challenges for malaria elimination in Brazil

Challenges for malaria elimination in Brazil

Analysis of polymorphisms in Plasmodium falciparum genes related to drug resistance: a survey over four decades under different treatment policies in Brazil

Path of infectious diseases in Brazil in the last 50 years: an ongoing challenge

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