Global Health Institute, University of Antwerp, Antwerp, Belgium; Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Peru.
Int J Infect Dis. 2021 Apr;105:293-297. doi: 10.1016/j.ijid.2021.02.042. Epub 2021 Feb 15.
Malaria continues to wreak havoc in the Peruvian Amazon. Lengthy research efforts have brought important lessons on its particular epidemiology: the heterogeneous levels of transmission, the large reservoir of both asymptomatic and submicroscopic infections, the co-transmission of Plasmodium vivax and Plasmodium falciparum in the same areas, and the limitations of current diagnostics. Based on these features, the national elimination program could greatly benefit from simplified standard treatment, with the use of artemisinin-based combination therapy and even shorter schemes of primaquine maintaing the total dosing. It is acknowledged that there is some uncertainty regarding the true prevalence of glucose-6-phosphate dehydrogenase deficiency (G6PD) and genetic polymorphisms related to cytochrome P-450 isozyme 2D6 functioning. Once we have a better understanding, tafenoquine, whether or not in combination with a rapid G6PD enzyme test, may become a future pathway to eliminate the otherwise hidden reservoir of the P. vivax hypnozoite through one standard Plasmodium treatment.
疟疾继续在秘鲁亚马逊地区肆虐。经过长期的研究，我们获得了有关其特殊流行病学的重要经验教训：传播水平不均、无症状和亚临床感染的巨大储存库、同一地区间间日疟原虫和恶性疟原虫的共同传播，以及当前诊断方法的局限性。基于这些特点，国家消除规划可以从简化标准治疗中获益匪浅，使用青蒿素为基础的联合疗法，甚至更短的方案，维持总剂量的磷酸萘酚喹。人们认识到，葡萄糖-6-磷酸脱氢酶缺乏症（G6PD）的真实流行率以及与细胞色素 P-450 同工酶 2D6 功能相关的遗传多态性存在一定程度的不确定性。一旦我们有了更深入的了解，磷酸萘酚喹是否与快速 G6PD 酶检测联合使用，都可能成为消除间日疟原虫休眠子这一隐藏感染源的未来途径，只需进行一次标准的疟疾治疗。
