Quashie Neils Ben, Akanmori Bartholomew D, Ofori-Adjei David, Goka Bamenla Q, Kurtzhals Jorgen A L
Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana.
J Trop Pediatr. 2006 Aug;52(4):254-9. doi: 10.1093/tropej/fmi110. Epub 2005 Dec 2.
A major manifestation of complicated malaria especially among children is severe anaemia, the pathogenesis of which is not well understood. Among other factors, suppression of the bone marrow's response to erythropoietin, which is rapidly reversed after successful treatment of the malaria, has been implicated in its pathogenesis. Since resolution of malaria restores erythropoiesis, we hypothesized that drug-resistant strains of Plasmodium falciparum would increase the risk of severe anaemia developing from initially uncomplicated malaria. Using both in vivo and in vitro drug-sensitivity tests we compared the prevalence of drug-resistant malaria between severe malarial anaemia SA and non-anaemic malaria NAM patients. Assessment of treatment outcome using the WHO in vivo criteria showed no significant difference in parasite resistance between the two groups. The mean parasite clearance time was also comparable. Treatment failures of about 14 per cent and 12 per cent were observed between SA and NAM patients respectively. The in vitro drug susceptibility test showed overall mean IC50 values of 0.41x10(-6) mol/l and 0.32x10(-6) mol/l blood for SA and NAM groups respectively. Geometric mean pre-treatment blood levels of chloroquine did not differ much between the two groups. Findings from this study could not therefore implicate drug-resistant parasites in the pathogenesis of severe malarial anaemia.
复杂型疟疾的一个主要表现，尤其是在儿童中，是严重贫血，其发病机制尚不完全清楚。在其他因素中，骨髓对促红细胞生成素反应的抑制（在成功治疗疟疾后迅速逆转）被认为与其发病机制有关。由于疟疾的缓解可恢复红细胞生成，我们推测恶性疟原虫的耐药菌株会增加最初无并发症的疟疾发展为严重贫血的风险。我们使用体内和体外药敏试验，比较了严重疟疾贫血（SA）患者和非贫血性疟疾（NAM）患者中耐药疟疾的患病率。使用世界卫生组织的体内标准评估治疗结果显示，两组之间的寄生虫耐药性没有显著差异。平均寄生虫清除时间也相当。SA组和NAM组患者的治疗失败率分别约为14%和12%。体外药敏试验显示，SA组和NAM组的总体平均IC50值分别为0.41x10（-6）mol/l和0.32x10（-6）mol/l血液。两组之间氯喹的几何平均治疗前血药水平差异不大。因此，本研究的结果并不表明耐药寄生虫与严重疟疾贫血的发病机制有关。
