Rabinovich S A, Tokmalaev A K, Kukina I V, Morozov E N, Maksakovskaia E V, Sadykova V D, Burchik M A, Ivanova T N, Sergiev V P
Med Parazitol (Mosk). 2010 Oct-Dec(4):46-8.
The efficiency of P. vivax malaria treatment with delagil (chloroquine) was evaluated in 122 patients, including 82 cases in Moscow and the Moscow region. The origin of the cases was malaria endemic areas in Asia, Africa, the Pacific Region, South America, and Transcaucasia. Forty other cases were imported malaria cases (secondary to imported ones), detected in Moscow and the Moscow region. Standard treatment with delagil (2.5 g) resulted in clinical improvement during 3 days in the majority of cases. Initial signs of degradation of asexual stages of P. vivax--kernels of nucleus, refinement of cytoplasm and its vacuolization, aggregation of pigment in isolated instances, its pushing out from cytoplasm--were observed after 1-2 hours after administration of delagil. Thereafter, parasite degradation was increasing, and it disappeared within 48 hours. Disappearance of fever slowed down in a few cases. However, degradation of parasites occurred during the same period among the rest of cases. It can not be excluded that fever was determined by the pyrogenic effect of remnants of degraded parasites and by the products of destroyed infected erythrocytes. It is probable that the findings of gametocytes, not completely degraded after disappearance of asexual forms in conjunction with prolonged fever, could result in a wrong conclusion of drug resistance. Negative results of microscopy and nested PCR on the last day of treatment, as well as in the following 10 days and absence of complains during 45 days, suggest the absence of resistance to delagil in P. vivax strains imported from different regions of the world. It is also probable that the literature on P. vivax resistance to chloroquine is limited to sporadic cases.
对122例间日疟患者使用氯喹进行治疗的疗效进行了评估，其中82例来自莫斯科及莫斯科地区。这些病例的来源地为亚洲、非洲、太平洋地区、南美洲和外高加索的疟疾流行区。另外40例为在莫斯科及莫斯科地区发现的输入性疟疾病例（继发于输入病例）。多数病例使用标准剂量氯喹（2.5克）治疗3天后临床症状有所改善。服用氯喹1 - 2小时后，观察到间日疟无性体开始出现退化迹象——细胞核核仁、细胞质细化及其空泡化、个别情况下色素聚集、色素从细胞质中排出。此后，寄生虫退化加剧，并在48小时内消失。少数病例发热消退缓慢。然而，其余病例在同一时期寄生虫均发生了退化。不能排除发热是由退化寄生虫残余物的致热作用以及被感染红细胞破坏产物所致。很可能在无性体消失后配子体未完全退化并伴有持续发热，从而导致关于耐药性的错误结论。治疗最后一天以及随后10天的显微镜检查和巢式PCR结果均为阴性，且45天内无不适主诉，表明从世界不同地区输入的间日疟菌株对氯喹不存在耐药性。间日疟对氯喹耐药的文献报道也可能仅限于散发病例。
