Price R, Nosten F, Simpson J A, Luxemburger C, Phaipun L, ter Kuile F, van Vugt M, Chongsuphajaisiddhi T, White N J
Shoklo Malaria Research Unit, Mae Sod, Tak Province, Thailand.
Am J Trop Med Hyg. 1999 Jun;60(6):1019-23. doi: 10.4269/ajtmh.1999.60.1019.
The factors affecting the development of patent Plasmodium falciparum gametocytemia were assessed in 5,682 patients entered prospectively into a series of antimalarial drug trials conducted in an area of low and seasonal transmission on the western border of Thailand. Of the 4,565 patients with admission thick smear assessments, 110 (2.4%) had gametocytemia. During the follow-up period 170 (3%) of all patients developed patent gametocytemia, which in 89% had developed by day 14 following treatment. In a multiple logistic regression model five factors were found to be independent risk factors at presentation for the development or persistence of gametocytemia during follow up; patent gametocytemia on admission (adjusted odds ratio [AOR] = 7.8, 95% confidence interval [CI] = 3.7-16, P < 0.001), anemia (hematocrit <30%) (AOR = 3.9, 95% CI = 2.3-6.5, P < 0.001), no coincident P. vivax malaria (AOR = 3.5, 95% CI = 1.04-11.5, P < 0.04), presentation with a recrudescent infection (AOR = 2.3, 95% CI = 1.3-4.1, P < 0.004), and a history of illness longer than two days (AOR = 3.3, 95% CI = 1.7-6.6, P < 0.001). Patients whose infections responded slowly to treatment or recrudesced subsequently were also more likely to carry gametocytes than those who responded rapidly or were cured (relative risks = 1.9, 95% CI = 1.3-2.7 and 2.8, 95% CI = 2.0-4.0, respectively; P < 0.001). These data provide further evidence of important epidemiologic interactions between P. falciparum and P. vivax, and drug resistance and transmission potential.
在泰国西部边境一个疟疾传播率低且呈季节性的地区，对前瞻性纳入一系列抗疟药物试验的5682例患者进行了评估，以确定影响恶性疟原虫配子体血症发生的因素。在4565例入院时进行厚涂片评估的患者中，110例（2.4%）有配子体血症。在随访期间，所有患者中有170例（3%）出现显性配子体血症，其中89%在治疗后第14天出现。在一个多元逻辑回归模型中，发现有五个因素是随访期间出现或持续存在配子体血症的独立危险因素；入院时显性配子体血症（调整优势比[AOR]=7.8，95%置信区间[CI]=3.7 - 16，P<0.001）、贫血（血细胞比容<30%）（AOR = 3.9，95%CI = 2.3 - 6.5，P<0.001）、无间日疟原虫合并感染（AOR = 3.5，95%CI = 1.04 - 11.5，P<0.04）、复发感染（AOR = 2.3，95%CI = 1.3 - 4.1，P<0.004）以及病程超过两天（AOR = 3.3，95%CI = 1.7 - 6.6，P<0.001）。感染对治疗反应缓慢或随后复发的患者比反应迅速或治愈的患者更有可能携带配子体（相对风险分别为1.9，95%CI = 1.3 - 2.7和2.8，95%CI = 2.0 - 4.0；P<0.001）。这些数据进一步证明了恶性疟原虫和间日疟原虫之间、耐药性和传播潜力之间重要的流行病学相互作用。
