Ketema Tsige, Bacha Ketema, Birhanu Tarekegn, Petros Beyene
Department of Biology, Addis Ababa University, Addis Ababa, Ethiopia.
Malar J. 2009 Jul 30;8:177. doi: 10.1186/1475-2875-8-177.
Ethiopia has the highest proportion of vivax malaria, approximately 40% of all malaria infections, in contrast to African countries. Chloroquine (CQ) is the drug of choice for the treatment of Plasmodium vivax infection in the country, although CQ resistant P. vivax (CRPv) has started to challenge the efficacy of the drug. The present study was conducted to assess the current status of CRPv at Serbo, Jimma zone, south-west Ethiopia.
A 28-day in vivo therapeutic efficacy test was conducted from October 2007 to January 2008. Recurrence of parasitaemia and the clinical condition of patients were assessed on each visit during the follow-up. The levels of haemoglobin (Hb) in the study participants were determined. The patients' blood drug levels were measured using HPLC. Data was analysed using SPSS for windows version 10.0. HPLC data was computed using Chem Station for LC 3D systems software.
Of the total 84 patients included in the study, 78 completed their 28-day follow-up, six of whom being excluded for different reasons. In three children (aged 7, 12 and 13 years), parasitaemia reappeared within the 28-days follow-up in spite of adequate absorption of the drug and absence of malaria symptom. In addition, on the day of recurrence of parasitaemia the levels of chloroquine-desethylchloroquine (CQ-DCQ) were above the minimum effective concentration (>or=100 etag/ml) in all the three cases, showing that treatment failure could not be attributed to low level of drug in the patients blood.
Reappearance of the parasite within the 28 days of follow-up is due to parasite resistance to CQ. The 3.6% (95% CI = -0.038 - 0.0758) prevalence of CRPv malaria in the study area signals the need for launching monitory activities for CQ resistant P. vivax. Moreover, as former report from the same country, Debrezeit, also showed the occurrence of CRPv, survey on CRPv malaria should be made in P. vivax endemic areas in order to estimate the level of burden across the country.
与其他非洲国家相比，埃塞俄比亚间日疟原虫疟疾的比例最高，约占所有疟疾感染的40%。氯喹（CQ）是该国治疗间日疟原虫感染的首选药物，尽管对氯喹耐药的间日疟原虫（CRPv）已开始对该药物的疗效构成挑战。本研究旨在评估埃塞俄比亚西南部吉马地区塞尔博CRPv的现状。
2007年10月至2008年1月进行了为期28天的体内治疗效果测试。在随访期间的每次就诊时评估寄生虫血症的复发情况和患者的临床状况。测定研究参与者的血红蛋白（Hb）水平。使用高效液相色谱法（HPLC）测量患者的血药水平。使用Windows版SPSS 10.0对数据进行分析。使用Chem Station for LC 3D系统软件计算HPLC数据。
在纳入研究的84名患者中，78名完成了28天的随访，其中6名因不同原因被排除。在3名儿童（7岁、12岁和13岁）中，尽管药物吸收充分且无疟疾症状，但在28天的随访期内仍出现了寄生虫血症复发。此外，在寄生虫血症复发当天，所有3例患者的去乙基氯喹（CQ-DCQ）水平均高于最低有效浓度（≥100 etag/ml），表明治疗失败不能归因于患者血液中药物水平过低。
随访28天内寄生虫复发是由于寄生虫对CQ耐药。研究地区CRPv疟疾的患病率为3.6%（95%CI = -0.038 - 0.0758），这表明需要针对对氯喹耐药的间日疟原虫开展监测活动。此外，正如该国德布雷齐特先前的报告也显示了CRPv的出现，应在间日疟原虫流行地区对CRPv疟疾进行调查，以估计全国的负担水平。
