Lee Jung Ah, Song Je Eun, Park Seong Yeon, Park Yoon Soo, Park Yoonseon, Kwak Yee Gyung, Lee Sang-Eun, Shin Hyun-Il, Yeom Joon-Sup
Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
Division of Infectious Diseases, Inje University Ilsan Paik Hospital, 170, Juhwa-ro, Ilsanseo-gu, Goyang-si, 10380, Gyeonggi-do, Republic of Korea.
BMC Infect Dis. 2025 Jan 21;25(1):93. doi: 10.1186/s12879-025-10501-9.
Although Plasmodium vivax (P. vivax) malaria is in the pre-elimination phase in the Republic of Korea (ROK), it continues to affect children and adolescents, who account for approximately 4-6% of the 300 to 500 annual cases. Despite this, research focusing on P. vivax malaria in this particular population remains limited. This study investigates the clinical characteristics of pediatric P. vivax malaria in the ROK from 2000 to 2016.
We retrospectively analyzed pediatric patients aged 0-18 years, diagnosed with P. vivax malaria in five hospitals in Goyang City and Seoul. Data on demographics, clinical presentations, treatment regimens, and outcomes were collected. Statistical analyses were performed for comparisons between severe and non-severe cases, across age groups, and assessing trends over time.
A total of 156 pediatric cases of indigenous P. vivax malaria were diagnosed. The median patient age was 13 years (men: 64.7%). Severe malaria occurred in 13.5% patients, predominantly in adolescents aged 15-18 years. The most common severe manifestations were jaundice (57.1%) and anemia (33.3%). In the ROK, the treatment regimen for pediatric P. vivax malaria involves oral administration of chloroquine at a dose of 25 mg base/kg divided over 3 days, followed by primaquine at a dose of 0.3 mg/kg for 14 days. Although all patients received chloroquine, a higher proportion of younger patients received a dose less than 25 mg/kg (87.5%, 85.5%, and 58.6% of those aged 0-4, 5-14, and 15-18 years, respectively; p < 0.001). Parasite clearance time (PCT) increased over the years, suggesting a potential decline in the chloroquine sensitivity of P. vivax. No deaths or significant long-term complications were reported.
Pediatric P. vivax malaria showed a low incidence of severe cases and no mortality in the ROK. Underdosing of antimalarial drugs was observed, underscoring the need for educating healthcare providers to ensure appropriate dosing. Increasing PCT highlights the need for ongoing surveillance of drug efficacy in this population. Further research on the evolving sensitivity of P. vivax and improved treatment protocols is thus essential.
尽管间日疟原虫疟疾在大韩民国处于消除前阶段，但它仍继续影响儿童和青少年，在每年300至500例病例中，儿童和青少年约占4%-6%。尽管如此，针对这一特定人群中间日疟原虫疟疾的研究仍然有限。本研究调查了2000年至2016年大韩民国儿童间日疟原虫疟疾的临床特征。
我们回顾性分析了在高阳和首尔的五家医院诊断为间日疟原虫疟疾的0至18岁儿科患者。收集了人口统计学、临床表现、治疗方案和结局的数据。进行了统计分析，以比较重症和非重症病例、不同年龄组之间的情况，并评估随时间的趋势。
共诊断出156例本土间日疟原虫疟疾儿科病例。患者中位年龄为13岁（男性占64.7%）。13.5%的患者发生重症疟疾，主要为15至18岁的青少年。最常见的严重表现是黄疸（57.1%）和贫血（33.3%）。在大韩民国，儿童间日疟原虫疟疾的治疗方案包括口服氯喹，剂量为25毫克碱基/千克，分3天服用，随后口服伯氨喹，剂量为0.3毫克/千克，服用14天。尽管所有患者都接受了氯喹治疗，但较年轻患者中接受剂量低于25毫克/千克的比例更高（0至4岁、5至14岁和15至18岁的患者分别为87.5%、85.5%和58.6%；p<0.001）。多年来寄生虫清除时间（PCT）有所增加，表明间日疟原虫对氯喹的敏感性可能下降。未报告死亡或严重的长期并发症。
在大韩民国，儿童间日疟原虫疟疾重症病例发生率低，无死亡病例。观察到抗疟药物剂量不足，这突出表明需要对医疗服务提供者进行教育，以确保适当的剂量。PCT增加凸显了对该人群药物疗效进行持续监测的必要性。因此，对间日疟原虫不断变化的敏感性以及改进治疗方案进行进一步研究至关重要。
