应用比色法（DELI）检测评估巴西亚马孙地区常见抗疟药物对恶性疟原虫和间日疟原虫的抗药性。
Use of a colorimetric (DELI) test for the evaluation of chemoresistance of Plasmodium falciparum and Plasmodium vivax to commonly used anti-plasmodial drugs in the Brazilian Amazon.
机构信息
Laboratório de Pesquisas em Malária, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, Brazil CEP: 21040-900.
出版信息
Malar J. 2013 Aug 12;12:281. doi: 10.1186/1475-2875-12-281.
BACKGROUND
The emergence and spread of Plasmodium falciparum and Plasmodium vivax resistance to available anti-malarial drugs represents a major drawback in the control of malaria and its associated morbidity and mortality. The aim of this study was to evaluate the chemoresistance profile of P. falciparum and P. vivax to commonly used anti-plasmodial drugs in a malaria-endemic area in the Brazilian Amazon.
METHODS
The study was carried out in Manaus (Amazonas state), in the Brazilian Amazon. A total of 88 P. falciparum and 178 P. vivax isolates was collected from 2004 to 2007. The sensitivity of P. falciparum isolates was determined to chloroquine, quinine, mefloquine and artesunate and the sensitivity of P. vivax isolates was determined to chloroquine and mefloquine, by using the colorimetric DELI test.
RESULTS
As expected, a high prevalence of P. falciparum isolates resistant to chloroquine (78.1%) was observed. The prevalence of isolates with profile of resistance or decreased sensitivity for quinine, mefloquine and artesunate was 12.7, 21.2 and 11.7%, respectively. In the case of P. vivax, the prevalence of isolates with profile of resistance for chloroquine and mefloquine was 9.8 and 28%, respectively. No differences in the frequencies of isolates with profile of resistance or geometric mean IC50s were seen when comparing the data obtained in 2004, 2005, 2006 and 2007, for all tested anti-malarials.
CONCLUSIONS
The great majority of P. falciparum isolates in the Brazilian malaria-endemic area remain resistant to chloroquine, and the decreased sensitivity to quinine, mefloquine and artesunate observed in 10-20% of the isolates must be taken with concern, especially for artesunate. Plasmodium vivax isolates also showed a significant proportion of isolates with decreased sensitivity to chloroquine (first-line drug) and mainly to mefloquine. The data presented here also confirm the usefulness of the DELI test to generate results able to impact on public health policies.
背景
恶性疟原虫和间日疟原虫对现有抗疟药物的抗药性的出现和传播是疟疾控制及其相关发病率和死亡率的主要障碍。本研究的目的是评估在巴西亚马逊地区疟疾流行地区常用抗疟药物对恶性疟原虫和间日疟原虫的化学耐药性。
方法
本研究在亚马逊州马瑙斯市进行。从 2004 年至 2007 年共收集了 88 株恶性疟原虫和 178 株间日疟原虫。采用比色 DELI 试验测定恶性疟原虫对氯喹、奎宁、甲氟喹和青蒿琥酯的敏感性，以及间日疟原虫对氯喹和甲氟喹的敏感性。
结果
正如预期的那样，观察到恶性疟原虫对氯喹的高耐药率（78.1%）。对奎宁、甲氟喹和青蒿琥酯的耐药或敏感性降低的分离株的流行率分别为 12.7%、21.2%和 11.7%。对于间日疟原虫，氯喹和甲氟喹耐药的分离株的流行率分别为 9.8%和 28%。在比较 2004 年、2005 年、2006 年和 2007 年获得的数据时，对于所有测试的抗疟药物，耐药或几何平均 IC50 的分离株的频率没有差异。
结论
巴西疟疾流行地区的恶性疟原虫分离株绝大多数仍对氯喹耐药，10-20%的分离株对奎宁、甲氟喹和青蒿琥酯的敏感性降低必须引起关注，特别是对青蒿琥酯。间日疟原虫分离株也显示出对氯喹（一线药物）和主要对甲氟喹敏感性降低的分离株的显著比例。这里提供的数据还证实了 DELI 试验生成能够影响公共卫生政策的结果的有用性。
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