Okech Bernard A, Existe Alexandre, Romain Jean R, Memnon Gladys, Victor Yves Saint, de Rochars Madsen Beau, Fukuda Mark
Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland
Department of Environmental and Global Health, University of Florida, Gainesville, Florida; Emerging Pathogens Institute, University of Florida, Gainesville, Florida; Laboratoire National de Santé Publique (LNSP), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; L'Hospital Saint Croix de Leogane, Pere Thevenot 1, Leogane, Haiti; Blanchard Clinic, Family Health Ministries Haiti, Port-au-Prince, Haiti; Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida; Armed Forces Health Sciences Surveillance Center, Silver Spring, Maryland.
Am J Trop Med Hyg. 2015 Mar;92(3):541-5. doi: 10.4269/ajtmh.14-0302. Epub 2015 Jan 19.
Chloroquine (CQ) has been used for malaria treatment in Haiti for several decades, but reports of CQ resistance are scarce. The efficacy of CQ in patients with uncomplicated Plasmodium falciparum undergoing treatment in Haiti was evaluated. Malaria patients were enrolled, treated with CQ, and monitored over a 42-day period. The treatment outcomes were evaluated on day 28 by microscopy. The P. falciparum slide-confirmed rate was 9.5% (121 of 1,277). Malaria infection was seasonal, with peak observations between October and January; 88% (107 of 121) of patients consented to participate. Sixty patients successfully completed the 42-day follow-up, whereas 47 patients withdrew consent or were lost to follow-up. The mean parasite density declined rapidly within the first few days after treatment. Seven patients did not clear their malaria infections and were clinically asymptomatic; therefore, they were considered late parasitological failures. About 90% (95% confidence interval = 84.20-97.90) of patients had no detectable parasitemia by day 28 and remained malaria-free to day 42. Testing for recrudescence, reinfection, and CQ serum levels was not done in the seven patients, and therefore, their CQ resistance status is unresolved. CQ resistance surveillance by patient follow-up, in vitro drug sensitivity studies, and molecular markers is urgently needed in Haiti.
氯喹（CQ）在海地用于疟疾治疗已有数十年，但关于CQ耐药性的报道却很少。我们评估了CQ在海地接受治疗的非复杂性恶性疟原虫患者中的疗效。招募疟疾患者，用CQ进行治疗，并在42天内进行监测。在第28天通过显微镜检查评估治疗结果。恶性疟原虫涂片确诊率为9.5%（1277例中的121例）。疟疾感染具有季节性，10月至1月间观察到的病例数最多；88%（121例中的107例）的患者同意参与。60例患者成功完成了42天的随访，而47例患者撤回同意或失访。治疗后的头几天内，平均寄生虫密度迅速下降。7例患者未清除疟疾感染且临床上无症状；因此，他们被视为晚期寄生虫学治疗失败。到第28天，约90%（95%置信区间=84.20 - 97.90）的患者未检测到疟原虫血症，并且到第42天仍未感染疟疾。未对这7例患者进行复发、再感染及CQ血清水平检测，因此，他们的CQ耐药状态尚未明确。海地迫切需要通过患者随访、体外药物敏感性研究及分子标记物来进行CQ耐药监测。
