Resposta dos plasmódios humanos aos antimaláricos na ilha de São Luís, estado do Maranhão, Brasil

Silva, A. Rafael Da; Carneiro, Ernane Wilson Bezerra; Santos, Henrique Jorge dos

doi:10.1590/s0036-46651984000300003

Cited by 15 publications

(9 citation statements)

References 3 publications

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“…Further similar cases were reported in Brazil in the 1980s in the states of Amazonas and Maranhão [5, 6]. For this reason, an alternative therapeutic regimen that combined sulphadoxine and pyrimethamine (SP) was adopted as the first line treatment recommendation.…”

Section: Introductionmentioning

confidence: 65%

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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Section: Introductionmentioning

confidence: 65%

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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“…Os percentuais de recaídas para o esquema I (cloroquina 25mg/kg de peso corporal administrada por três dias, associada à primaquina por quatorze dias), foram de 5%, semelhantes aos achados no Maranhão, de 5,6% de recaídas com o uso do esquema clássico 18 . Entretanto, diferem dos dados obtidos em São Paulo, onde o índice de recaídas foi de 24,5% para o esquema padrão 2 .…”

Section: Discussionunclassified

Avaliação da resposta aos esquemas de tratamento reduzidos para malária vivax

Abdon

Pinto

Silva

et al. 2001

Rev. Soc. Bras. Med. Trop.

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Resumo Recaídas que podem ocorrer com o tratamento convencional de longa duração para malária por P. vivax, são em parte devido a parcial adesão do paciente ao tratamento. A utilização de esquemas terapêuticos de curta duração pode proporcionar melhor adesão ao tratamento, mantendo a eficácia e tolerância e minimizando efeitos adversos. Com o objetivo de testar 2 esquemas terapêuticos com doses reduzidas de cloroquina para malária por P.vivax, comparando-o ao esquema clássico, os autores estudaram 120 pacientes, diagnosticados pela gota espessa, com idade superior a 12 anos, submetidos a três esquemas de tratamento: esquema I: fosfato de cloroquina (150mg), 25mg/kg (dose total), durante três dias (10mg/kg de peso no primeiro dia; 7,5mg/kg no segundo e terceiro dias), associada a primaquina (15mg), 0,25mg/kg/dia, por quatorze dias; esquema II: cloroquina, 10mg/kg, em dose única, associada a primaquina, 0,5mg/kg/dia, por sete dias; esquema III: cloroquina, 10mg/kg em dose única, associada a primaquina, 0,5mg/kg/dia, por cinco dias. A resposta de cura clínica aos três esquemas foi satisfatória. O desaparecimento da tríade sintomática ocorreu no máximo em até 96 horas, e a negativação da parasitemia assexuada ocorreu em até 72 horas, para os três esquemas. Palavras-chaves: Malária vivax. Tratamento reduzido. Cloroquina.Abstract Relapses may occur with long standard treatment of vivax malaria, and these are caused by incomplete patient's compliance. The use of reduced schedules may further better patient compliance, while maintaining the same efficacy, tolerance and minimal adverse reactions. The objective of this study was to test two schedules with reduced doses of chloroquine for vivax malaria and comparing these with the classical schedule. The authors studied 120 outpatients, with vivax malaria, aged over 12 years, submitted to three therapeutic schemes: scheme I: chloroquine phosphate (150mg) in a dose of 25mg/kg/day for three days (10mg/kg/ day in the first day, 7.5mg/kg/day in the second and third day), plus primaquine (15mg) in a dose of 0.25mg/kg/day for fourteen days; scheme II: chloroquine, in a single dose of 10mg/kg, plus primaquine in a dose of 0.5mg/kg/day for seven days; scheme III: chloroquine, 10mg/kg in a single dose plus primaquine in a dose 0.5mg/kg/ day for five days. The clinical response to all three therapeutic schemes was satisfactory. The disappearance of malarial symptoms occurred after a maximum 96 hours of treatment, while the assexual parasitaemia clearance occurred within 72 hours, in all therapeutic schemes. Key-words: Vivax malaria. Reduced treatment. Chloroquine. A malária produzida pelo Plasmodium vivax, por ser considerada benigna e autolimitada, pode levar à suspeição diagnóstica imprecisa e conseqüentemente a terapêutica imprópria, além de complicações que poderão surgir, sobretudo àquelas relacionadas a anemia. O esquema terapêutico adotado pela Fundação Nacional de Saúde, para o tratamento radical da malária por P. vivax, era realizado em quatorze dias. Apesar de eficaz, este...

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“…notificaron una tasa de falla de 14% en pacientes con tratamiento supervisado en una zona no endémica de Brasil 12 . En la región amazónica de Brasil se ha descrito 5-10% de recaídas, posiblemente secundarias a una falla terapéutica en temporada de baja incidencia de la infección 13 . La falla al tratamiento radical de la infección por P. vivax y las dificultades para identificar su causa constituyen un escenario complejo.…”

Section: P Lasmodium Vivax (P Vivax) Es El Agente Etiológicounclassified