Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Clin Infect Dis. 2011 Mar 1;52(5):612-20. doi: 10.1093/cid/ciq249.
Plasmodium vivax malaria commonly follows treatment of falciparum malaria in regions of co-endemicity. This is an important cause of preventable morbidity.
We examined the factors contributing to the risk of recurrence of P. vivax infection after treatment of acute falciparum malaria in a series of clinical trials conducted on the Thai-Myanmar border from 1991 through 2005.
Overall, 10,549 patients (4960 children aged <15 years and 5589 adults) were treated for falciparum malaria; of these patients, 9385 (89.0%) had Plasmodium falciparum monoinfection and 1164 (11.0%) had mixed P. falciparum/P. vivax infections according to microscopic examinations performed at screening. The cumulative proportion of patients with P. falciparum infection recurrence by day 63 was 21.5% (95% confidence interval [CI], 20.3%-22.8%), and the cumulative proportion with P. vivax infection recurrence was 31.5% (95% CI, 30.1%-33.0%). Significant risk factors for P. vivax infection recurrence were mixed infection at enrollment, male sex, younger age, lower hematocrit, higher asexual P. falciparum parasite density (P < .001 for all factors), and P. falciparum gametocytemia at enrollment (P = .001). By day 63, the cumulative risk of vivax malaria after P. falciparum monoinfection was 51.1% (95% CI, 46.1%-56.2%) after treatment with rapidly eliminated drugs (t(1/2) <1 day), 35.3% (95% CI, 31.8%-39.0%) after treatment with intermediate half-life drugs (t(1/2) 1-7 days), and 19.6% (95% CI, 18.1%-21.3%) after treatment with slowly eliminated drugs (t(1/2) > 7 days) (P < .001, by test for trend). Artemisinin-based combinations containing mefloquine or piperaquine, compared with the artemether-lumefantrine and artesunate-atovaquone-proguanil combinations, were associated with a 3.6-fold to 4.2-fold lower adjusted hazard ratio for P. vivax infection recurrence within 63 days after pure or mixed P. falciparum infections (P < .001, for comparisons with artesunate-mefloquine).
On the Thai-Myanmar border, P. vivax is the most common cause of parasitological failure after treatment for falciparum malaria. Slowly eliminated antimalarials reduce the risk of early P. vivax infection recurrence.
在流行地区，间日疟原虫疟疾通常紧随恶性疟原虫疟疾的治疗而发生。这是可预防发病的一个重要原因。
我们在从 1991 年到 2005 年于泰国-缅甸边境进行的一系列临床试验中，研究了在治疗急性恶性疟原虫疟疾后发生间日疟原虫再感染的风险因素。
共有 10549 例患者（4960 例年龄＜15 岁的儿童和 5589 例成人）因恶性疟原虫疟疾接受治疗；根据筛查时进行的显微镜检查，这些患者中 9385 例（89.0%）为恶性疟原虫单纯感染，1164 例（11.0%）为恶性疟原虫/间日疟原虫混合感染。第 63 天的恶性疟原虫再感染累积比例为 21.5%（95%置信区间[CI]，20.3%-22.8%），间日疟原虫再感染的累积比例为 31.5%（95%CI，30.1%-33.0%）。间日疟原虫再感染的显著风险因素包括入组时混合感染、男性、年龄较小、较低的血细胞比容、较高的无性期恶性疟原虫寄生虫密度（所有因素均＜0.001）和入组时恶性疟原虫配子体血症（P=0.001）。第 63 天，在快速消除药物（t(1/2)＜1 天）治疗后，恶性疟原虫单纯感染后间日疟的累积风险为 51.1%（95%CI，46.1%-56.2%），在中间半衰期药物（t(1/2)1-7 天）治疗后为 35.3%（95%CI，31.8%-39.0%），在缓慢消除药物（t(1/2)＞7 天）治疗后为 19.6%（95%CI，18.1%-21.3%）（P＜0.001，趋势检验）。与青蒿琥酯-甲氟喹和青蒿琥酯-阿托伐醌-磺胺多辛-乙胺嘧啶组合相比，含甲氟喹或哌喹的青蒿素类复方疗法治疗单纯或混合恶性疟原虫感染后 63 天内间日疟原虫再感染的调整风险比降低了 3.6 至 4.2 倍（P＜0.001，与青蒿琥酯-甲氟喹比较）。
在泰国-缅甸边境，间日疟原虫是恶性疟原虫疟疾治疗后寄生虫学失败的最常见原因。缓慢消除的抗疟药物可降低早期间日疟原虫再感染的风险。
