Esterre P, Volney B, Meynard J-B, Legrand E
CNRCP, Institut Pasteur de Guyane, BP6010, Cayenne Cédex, Guyane française.
Bull Soc Pathol Exot. 2009 Aug;102(3):179-84.
A regular implementation of prophylactic and therapeutic decision trees was organized on a consensus basis in Cayenne, French Guiana in 1990, 1995 and 2002. The updated recommendations were based on the knowledge of the in vitro chemosensitivity profiles of the local isolates, mainly coming from big rivers (Maroni and Oyapock, frontiers with Suriname and Brazil, respectively; and more recently Approuague). Most of the patients infected by Plasmodium falciparum were followed by the medical staff of the main hospitals (Cayenne and Saint-Laurent) and of the peripheral health centers in remote areas. Consequently the epidemiological situation and evolution of chemoresistance have been widely observed on a long-term (since 1994) basis in the Maroni region. Yet, we have only partial information coming from the Oyapock valley, even though an important (most of the time) illegal immigration has been developing since the 90s' leading to a notable modification of the epidemiological status of malaria in this eastern region, including a regular increase of P. vivax infections. Presently very little P. vivax chloroquine (and mefloquine) resistance has been identified but this result could lead to a real public health problem in a near future. As such, the National Reference Center on Plasmodium Chemoresistance in the French West Indies and Guiana (CNRCP-AG in French) is a unique observatory of malaria chemoresistance in the Guyanese shield which works with research laboratories of the Institut Pasteur, Paris. This network strategy offers a very attractive perspective for applications of modern tools, including the validation of chemoresistance molecular markers, for malaria control at both medical and public health levels. Some examples related to chloroquine and artemether resistance are given.
1990年、1995年和2002年，法属圭亚那的卡宴在共识基础上定期组织实施预防性和治疗性决策树。更新后的建议基于对当地分离株体外化学敏感性谱的了解，这些分离株主要来自大河（分别是与苏里南和巴西接壤的马罗尼河和奥亚波克河，以及最近的阿普鲁阿格河）。大多数感染恶性疟原虫的患者由主要医院（卡宴和圣洛朗）以及偏远地区的周边卫生中心的医务人员跟踪。因此，自1994年以来，在马罗尼地区长期广泛观察到了抗药性的流行病学情况和演变。然而，尽管自90年代以来一直存在重要的（大多数时候是非法的）移民，导致该东部地区疟疾的流行病学状况发生了显著变化，包括间日疟原虫感染的定期增加，但我们从奥亚波克山谷获得的信息仍然不完整。目前，已发现很少的间日疟原虫对氯喹（和甲氟喹）耐药，但这一结果可能在不久的将来导致一个真正的公共卫生问题。因此，法属西印度群岛和圭亚那国家疟原虫抗药性参考中心（法语为CNRCP - AG）是圭亚那地盾地区疟疾抗药性的唯一观测站，它与巴黎巴斯德研究所的研究实验室合作。这种网络策略为现代工具的应用提供了一个非常有吸引力的前景，包括在医学和公共卫生层面验证抗药性分子标记以控制疟疾。文中给出了一些与氯喹和蒿甲醚抗药性相关的例子。
