Longley Rhea J, Sripoorote Piyarat, Chobson Pornpimol, Saeseu Teerawat, Sukasem Chonlaphat, Phuanukoonnon Suparat, Nguitragool Wang, Mueller Ivo, Sattabongkot Jetsumon
Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
Am J Trop Med Hyg. 2016 Nov 2;95(5):1086-1089. doi: 10.4269/ajtmh.16-0410. Epub 2016 Sep 6.
Primaquine is the only licensed antimalarial drug that is capable of clearing dormant Plasmodium vivax liver stage parasites. To date, there is no clear evidence of resistance of the liver stage parasite against this drug, because of the difficulty in ascertaining the cause of recurrent infection. We followed 52 Thai P. vivax patients for 9 months after directly observed treatment of 15 mg primaquine daily for 14 days. Blood samples taken at 2-4 weekly intervals were assessed by microscopy and polymerase chain reaction (PCR) for the presence of parasites. Only four of 52 (7.7%) volunteers had recurrent P. vivax infections, all at least 8 weeks after treatment. This demonstrates that primaquine retains a high efficacy in this population. Although a risk of new infections could not be ruled out, parasite genotyping at two polymorphic markers suggested a high probability of late relapsing infections in these volunteers. Continued monitoring of primaquine efficacy in this region is advisable.
伯氨喹是唯一一种获得许可的能够清除间日疟原虫肝脏期休眠寄生虫的抗疟药物。迄今为止，由于难以确定复发性感染的原因，尚无明确证据表明肝脏期寄生虫对该药物产生耐药性。我们对52例泰国间日疟患者进行了随访，在直接观察下给予患者每日15毫克伯氨喹，持续治疗14天，之后随访9个月。每隔2 - 4周采集血样，通过显微镜检查和聚合酶链反应（PCR）评估是否存在寄生虫。52名志愿者中只有4人（7.7%）出现间日疟复发感染，均在治疗后至少8周。这表明伯氨喹在该人群中仍保持高效。虽然不能排除新感染的风险，但对两个多态性标记进行的寄生虫基因分型表明，这些志愿者出现晚期复发感染的可能性很高。建议持续监测该地区伯氨喹的疗效。
