Ghimire Prakash, Rijal Komal Raj, Kafle Chandramani, Karki Balman Singh, Singh Nihal, Ortega Leonard, Thakur Garib Das, Adhikari Bipin
1Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
2KIST Medical College, Gawrko, Lalitpur, Nepal.
Trop Dis Travel Med Vaccines. 2018 Aug 14;4:9. doi: 10.1186/s40794-018-0068-2. eCollection 2018.
The national treatment guidelines of Nepal have adopted Artemisinin Combination Therapies (ACTs) for the treatment of uncomplicated falciparum malaria since 2004. Emergence of Artemisinin resistance in the Greater Mekong Sub-region (GMS) and beyond may become a threat for Nepal as well. The main objective of this study was to assess the therapeutic efficacy of antimalarial drug artemether-lumefantrine in uncomplicated infected patients at health centers/hospitals treated over the period of 2 years (2013-2014).
Giemsa stained thick and thin smears, prepared from uncomplicated falciparum malaria patients who visited the selected sentinel sites in Nepal during 2013 to 2014 and met the inclusion criteria that included parasitemia (1000-10,000 /μL of blood), were evaluated until 28 days after ACTs treatment, following a World Health Organization (WHO) therapeutic efficacy protocol. Based on the re-occurrence of fever and resurge in parasitemia, the study patients were classified as resistant or susceptible. Blood specimens on filter papers were further analyzed by Polymerase Chain Reaction (PCR), specifically for the K13 propeller gene mutation (a recently identified molecular marker for ACT resistance).
A total of 56,013 suspected malaria cases were screened for this study. Of which, 120 (0.21%) were infected with falciparum malaria. Out of 120, 28 cases of 28/120; 23.33%) were enrolled in the study, of which 24 cases completed the post-treatment follow up for 28 days. Only one case out of 24 (4%) was identified as a late treatment failure (LTF). K13 mutation, a proxy indicator for ACT resistance in parasites, was not detected on the day 1, which indicates resistance had not yet reached the molecular level.
Only one case of late treatment failure was identified in this study. ACT combination using artemether-lumefantrine was still effective for the treatment of uncomplicated falciparum malaria in Nepal. A close monitoring and supervision for ACT resistance is essential for future malaria treatment in Nepal.
自2004年以来，尼泊尔的国家治疗指南采用青蒿素联合疗法（ACTs）治疗非复杂性恶性疟。大湄公河次区域（GMS）及其他地区出现的青蒿素耐药性可能也会对尼泊尔构成威胁。本研究的主要目的是评估抗疟药物蒿甲醚-本芴醇在2年期间（2013 - 2014年）于卫生中心/医院接受治疗的非复杂性感染患者中的治疗效果。
根据世界卫生组织（WHO）的治疗效果方案，对2013年至2014年期间前往尼泊尔选定哨点、符合纳入标准（包括疟原虫血症，即每微升血液中疟原虫数为1000 - 10000个）的非复杂性恶性疟患者制备的吉姆萨染色厚涂片和薄涂片进行评估，直至ACTs治疗后28天。根据发热复发和疟原虫血症复燃情况，将研究患者分类为耐药或敏感。对滤纸上的血液标本进一步采用聚合酶链反应（PCR）进行分析，特别是针对K13螺旋桨基因突变（一种最近确定的ACT耐药分子标记）。
本研究共筛查了56013例疑似疟疾病例。其中，120例（0.21%）感染了恶性疟。在这120例中，28例（28/120；23.33%）纳入研究，其中24例完成了28天的治疗后随访。24例中仅有1例（4%）被确定为晚期治疗失败（LTF）。在第1天未检测到K13突变（寄生虫中ACT耐药的替代指标），这表明耐药性尚未达到分子水平。
本研究仅发现1例晚期治疗失败病例。使用蒿甲醚-本芴醇的ACT联合疗法对尼泊尔非复杂性恶性疟的治疗仍然有效。对ACT耐药性进行密切监测和监督对尼泊尔未来的疟疾治疗至关重要。
