“…In order to avoid such a impairment, resistance monitoring is of uppermost importance, at best by in vivo and in vitro methods. The present study confirmed the high level of resistance to chloroquine previously demonstrated in other areas of the Amazon basin (Boulos et al 1986, Alecrim 1986, Di Santi et al 1988, Zalis et al 1998. Regarding quinine, besides the low true-resistance percentage observed (3.3%), IC 50s to the tested samples were as high as those observed in other areas of the world with decreased susceptibility (Webster et al 1985), suggesting that the usefulness of the drug will not last for a long time.…”
Section: Discussionsupporting
confidence: 90%
“…Migrant populations disseminate resistant strains throughout the region and lead them to malaria free areas, increasing the risks of outbreaks (Marques 1986). Plasmodium falciparum drug resistance in Brazil has developed at an alarming rate to chloroquine, Fansidar® and to some extent quinine (Boulos et al 1986). As vector control is not a realistic approach in this region, early diagnosis and effective treatment are essential tools for control strategies.…”
mentioning
confidence: 99%
“…Malaria prevalence in Brazil has increased three times during the past and quinine in those studies were too low, leading to overestimation of the resistance percentages (Alecrim 1986, Di Santi et al 1988) When adequate "cut off" limits are employed, taking together in vivo and in vitro data, parasite resistance has been observed at levels greater than 70% to chloroquine, greater than 60% to sulfadoxine-pyrimethamine, lower than 20% to quinine and almost none to mefloquine (Boulos et al 1986, Alecrim 1986, Di Santi et al 1988, Kremsner et al 1989, Souza 1992, Couto et al 1993. As in vitro evaluations of P. falciparum sensitivity have not been performed since the 80's (Di Santi et al 1988, Kremsner et al 1989, and considering that radioisotopic methods had not been used, except in one occasion (Zalis et al 1998), we decided to verify the patterns of resistance in a typical endemic area of the Brazilian Amazon region.…”
“…In order to avoid such a impairment, resistance monitoring is of uppermost importance, at best by in vivo and in vitro methods. The present study confirmed the high level of resistance to chloroquine previously demonstrated in other areas of the Amazon basin (Boulos et al 1986, Alecrim 1986, Di Santi et al 1988, Zalis et al 1998. Regarding quinine, besides the low true-resistance percentage observed (3.3%), IC 50s to the tested samples were as high as those observed in other areas of the world with decreased susceptibility (Webster et al 1985), suggesting that the usefulness of the drug will not last for a long time.…”
Section: Discussionsupporting
confidence: 90%
“…Migrant populations disseminate resistant strains throughout the region and lead them to malaria free areas, increasing the risks of outbreaks (Marques 1986). Plasmodium falciparum drug resistance in Brazil has developed at an alarming rate to chloroquine, Fansidar® and to some extent quinine (Boulos et al 1986). As vector control is not a realistic approach in this region, early diagnosis and effective treatment are essential tools for control strategies.…”
mentioning
confidence: 99%
“…Malaria prevalence in Brazil has increased three times during the past and quinine in those studies were too low, leading to overestimation of the resistance percentages (Alecrim 1986, Di Santi et al 1988) When adequate "cut off" limits are employed, taking together in vivo and in vitro data, parasite resistance has been observed at levels greater than 70% to chloroquine, greater than 60% to sulfadoxine-pyrimethamine, lower than 20% to quinine and almost none to mefloquine (Boulos et al 1986, Alecrim 1986, Di Santi et al 1988, Kremsner et al 1989, Souza 1992, Couto et al 1993. As in vitro evaluations of P. falciparum sensitivity have not been performed since the 80's (Di Santi et al 1988, Kremsner et al 1989, and considering that radioisotopic methods had not been used, except in one occasion (Zalis et al 1998), we decided to verify the patterns of resistance in a typical endemic area of the Brazilian Amazon region.…”
“…Aparentemente, a pior resposta encontrada com a associação de quinino com sulfadoxina e pirimetamina, quando comparada ao quinino, se deve ao fato de se utilizar quinino por apenas 3 dias nessa associação e corrobora com a conhecida resistência disseminada do P. falciparum à associação sulfadoxina-pirimetamina 3 .…”
O quinino foi o primeiro medicamento correntemente usado para tratar malária, tendo sido abandonado seu emprego principalmente após o início do emprego da cloroquina. A partir da década de 60 com o surgimento de resistência do P. falciparum à cloroquina voltou-se a utilizar o quinino isolado ou em associação para tratar tal infecção. Com o objetivo de avaliar clinicamente a resposta ao quinino de pacientes com malária por P. falciparum, analisamos os prontuários de 484 pacientes atendidos no Laboratório de Malária da SUCEN e acompanhados por pelo menos 28 dias, e que haviam recebido diferentes esquemas terapêuticos com quinino isolado ou em associação. Do total, 81,0% dos pacientes foram curados pelos esquemas empregados, sendo que dos restantes apenas 0,6% foram R2 e nenhum R3. Tais resultados mostram ainda que esquemas contendo quinino podem ser adequados para tratar malária por P. falciparum.
“…Por vezes o quadro da malária cerebral lembra o da meningite ou do téta-no, da epilepsia, do alcoolismo dentre outras enfermidades neurológicas. 8 …”
Section: Malária: Casuística E Infecçãounclassified
IntroduçãoCerca de 10% da população mundial é portadora assintomática de dois tipos importantes de anemia hereditá-ria: doença falciforme e talassemias. Ambas apresentam distribuição geográfica bastante diversificada na África, Ásia, Europa e América, apesar de originalmente estarem confinadas nas regiões tropicais e subtropicais. Desde a década de 50 tem sido discutido que as altas prevalências dessas duas anemias hereditárias, assim como a causada pela deficiência de glicose-6-fosfato desidrogenase, se deve à proteção seletiva de seus heterozigotos contra os efeitos letais das infecções causadas pelo Plasmodium falciparum. Uma similaridade entre a distribuição geográfica da α-talassemia e a incidência de malária em algumas áreas também tem sido demonstrada; entretanto, os mecanismos de proteção dos heterozigotos talassêmicos não são completamente compreendidos.2 Apesar de décadas de estudos epidemiológicos e especulações, o modo de seleção que favorece o gene da hemoglobina S continua pouco conhecido. Lisa et al (1994) 3 propuseram que a fertilidade diferencial seria uma explicação para a manutenção do polimorfismo de hemoglobinopatias em algumas populações.
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