在埃塞俄比亚西南部的 Gamo 地区的 Arba Minch Zuria 区，蒿甲醚-本芴醇治疗无并发症恶性疟原虫疟疾的疗效。

Therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Arba Minch Zuria District, Gamo Zone, Southwest Ethiopia.

机构信息

Department of Biology, Arba Minch University, Arba Minch, Ethiopia.

Department of Biology, Madda Walabu University, Bale Robe, Ethiopia.

出版信息

Malar J. 2024 Sep 17;23(1):282. doi: 10.1186/s12936-024-05087-7.

DOI:10.1186/s12936-024-05087-7

PMID:39289715

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11406784/

Abstract

BACKGROUND

Artemether-lumefantrine (AL) has been the primary anti-malarial drug used to treat uncomplicated Plasmodium falciparum malaria in Ethiopia since 2004. However, there have been recent reports of AL resistance mutations in different African countries, including Ethiopia. This is concerning and requires periodic monitoring of anti-malarial drug resistance. Therefore, the current study aimed to evaluate the therapeutic efficacy of AL in treating uncomplicated P. falciparum malaria in the Arba Minch Zuria District, Gamo Zone, Southwest Ethiopia.

METHODS

A single-arm prospective study with a 28-day follow-up period was conducted from July to October 2022. Capillary blood samples were collected for RDT and microscopic examination. The study enrolled monoinfected P. falciparum patients aged ≥ 18 years at Ganta Sira Health Post. Sociodemographic and clinical data were recorded, and a dried blood spot (DBS) was prepared for each participant. Nested polymerase chain reaction (nPCR) genotyping of the msp-1 and msp-2 genes was only performed for recurrent cases to distinguish between recurrence and reinfection. Data entry and analysis were performed using the WHO Excel spreadsheet and SPSS version 26.

RESULTS

A total of 89 patients were enrolled, and 67 adequately completed the 28-day follow-up period. AL showed a 100% clearance rate for fever on day 2 and asexual parasites on day 3. Gametocytes were detected in 13.5% (12/89) of the participants. The gametocyte clearance rate was 58.3% (7/12) until day 7 and 100% (12/12) until day 14. Five participants developed recurrent malaria, three of whom experienced relapse and two of whom experienced reinfection. Based on the Kaplan-Meier survival analysis, the PCR-uncorrected and PCR-corrected cumulative incidence of success were 93.7% (95% CI 85.5-97.3) and 96.2% (95% CI 85.5-98.7), respectively.

CONCLUSION

AL was efficacious in treating uncomplicated P. falciparum malaria in the study area. However, the detection of recurrent patients highlights the need for continuous efficacy studies in this area.

摘要

背景

自 2004 年以来，蒿甲醚-本芴醇（AL）一直是埃塞俄比亚治疗无并发症恶性疟原虫疟疾的主要抗疟药物。然而，最近有报道称，包括埃塞俄比亚在内的不同非洲国家出现了 AL 耐药突变。这令人担忧，需要定期监测抗疟药物耐药性。因此，本研究旨在评估 AL 在治疗埃塞俄比亚西南部 Gamo 地区 Arba Minch Zuria 区无并发症恶性疟原虫疟疾中的疗效。

方法

这是一项单臂前瞻性研究，随访期为 28 天，于 2022 年 7 月至 10 月进行。采集毛细血管血样进行 RDT 和镜检。研究在 Ganta Sira 卫生站招募了年龄≥18 岁的单一感染恶性疟原虫的患者。记录社会人口学和临床数据，并为每位参与者制备干血斑（DBS）。仅对复发病例进行 msp-1 和 msp-2 基因的巢式聚合酶链反应（nPCR）基因分型，以区分复发和再感染。使用世卫组织 Excel 电子表格和 SPSS 版本 26 进行数据录入和分析。

结果

共纳入 89 例患者，其中 67 例患者完成了 28 天的随访期。AL 在第 2 天和第 3 天对发热和无性寄生虫的清除率均为 100%。在 13.5%（12/89）的参与者中检测到配子体。配子体清除率在第 7 天为 58.3%（7/12），在第 14 天为 100%（12/12）。5 例患者发生复发性疟疾，其中 3 例为复发，2 例为再感染。基于 Kaplan-Meier 生存分析，未经 PCR 校正和经 PCR 校正的累积成功率分别为 93.7%（95%CI 85.5-97.3）和 96.2%（95%CI 85.5-98.7）。