Verdrager J
J Trop Med Hyg. 1986 Dec;89(6):277-89.
A review is presented of the development of drug-resistant malaria in Païlin on the Thai-Kampuchean border and its spread to other parts of the region and beyond. Resistance of P. falciparum to chloroquine appears to have emerged in this area in the early 1960s and evidence of resistance to the combination of sulfadoxine and pyrimethamine and to the combination of diaphenylsulfone and pyrimethamine came from the same area towards the end of the same decade. The factors leading to the emergence and increase of drug resistance appear to have been: the continuous introduction of non-immune migrants to a hyperendemic malaria area, an increase in already intense transmission resulting from the living and working conditions of the migrants and prolonged drug pressure resulting from individual drug consumption and mass drug administration, particularly from the medicated salt project which covered the area in which resistance emerged. These conditions lead to the selection of resistant mutants. Moreover, resistant parasites were exposed to multiple and increasing doses of chloroquine, pyrimethamine and sulfathiazole during repeated passages through non-immune hosts who were being treated for primary attacks, early recrudescences and reinfections. This probably resulted in increasing the degree of resistance and in the selection of parasites resistant to sulfathiazole with cross-resistance to other sulfonamides. In Irian Jaya, Indonesian New Guinea, where there had been a chloroquinized salt project, the level of chloroquine resistance was much lower than in Païlin; this is associated with the absence of a non-immune population and the lower dose of chloroquine base used in the salt. The spread of chloroquine resistance is then discussed. At first resistance was found only in three foci in South-East Asia where A. balabacensis is the vector of malaria. It then spread to all A. balabacensis areas, and finally to areas outside the area of distribution of A. balabacensis. The spread of resistance is found to be favoured by the presence of the vector A. balabacensis and by the introduction of a non-immune population.
本文综述了泰国-柬埔寨边境拜林地区耐药性疟疾的发展情况及其向该地区其他地方乃至更广泛地区的传播。恶性疟原虫对氯喹的耐药性似乎于20世纪60年代初在该地区出现，而对周效磺胺与乙胺嘧啶合剂以及二苯砜与乙胺嘧啶合剂耐药的证据在同一十年末也来自同一地区。导致耐药性出现和增加的因素似乎包括：不断有非免疫的移民进入疟疾高度流行地区，移民的生活和工作条件导致原本就很强烈的传播增加，以及个人用药和大规模药物管理（特别是覆盖耐药性出现地区的药盐项目）造成的长期药物压力。这些情况导致了耐药突变体的选择。此外，耐药寄生虫在通过接受初发、早期复发和再感染治疗的非免疫宿主反复传代过程中，接触到了多种且剂量不断增加的氯喹、乙胺嘧啶和磺胺噻唑。这可能导致耐药程度增加，并选择出对磺胺噻唑耐药且对其他磺胺类药物有交叉耐药性的寄生虫。在印度尼西亚新几内亚的伊里安查亚，曾有一个氯喹盐项目，那里的氯喹耐药水平远低于拜林；这与不存在非免疫人群以及盐中使用的氯喹碱剂量较低有关。随后讨论了氯喹耐药性的传播情况。起初，耐药性仅在东南亚三个以巴拉巴按蚊为疟疾传播媒介的疫源地被发现。然后它传播到了所有巴拉巴按蚊分布的地区，最终传播到了巴拉巴按蚊分布区域之外的地区。发现耐药性的传播受到巴拉巴按蚊媒介的存在以及非免疫人群的引入的促进。
