Le Bras J, Longuet C, Charmot G
Centre national de référence de la chimiosensibilité du paludisme Hôpital Bichat-Claude-Bernard, Paris.
Rev Prat. 1998 Feb 1;48(3):258-63.
There is no longer malaria transmission in Europe and North America, while the transmission decreases in sub-tropical areas and increases in tropical countries. Most of malarias are now due to Plasmodium falciparum and happen in Africa. In the regions where the transmission is high, malaria is stable, baby mortality is high, and protective immunity is achieved in early childhood. Falciparum resistant malaria originates from mutations on drug target decreasing affinity to antifols, or mutations preventing accumulation of chloroquine in parasitized red blood cells. Resistance is a rapid event following large use of antifols, even associated, while falciparum chloroquine resistance is now widespread. Resistance to quinine, mefloquine and halofantrine is still at low levels out of Thailand, as their use remains through medical hands. Non resistance was observed yet with artemisinin derivatives.
欧洲和北美已不再有疟疾传播，而亚热带地区的传播有所减少，热带国家的传播则有所增加。目前大多数疟疾是由恶性疟原虫引起的，且发生在非洲。在传播率高的地区，疟疾呈稳定状态，婴儿死亡率高，儿童早期可获得保护性免疫。恶性疟原虫抗药性疟疾源于药物靶点的突变，这种突变降低了对抗叶酸药物的亲和力，或者阻止氯喹在被寄生的红细胞中蓄积。在大量使用抗叶酸药物后，抗药性迅速出现，甚至同时出现，而恶性疟原虫对氯喹的抗药性目前已广泛存在。在泰国以外地区，对奎宁、甲氟喹和卤泛群的抗药性仍处于低水平，因为它们仍通过医疗途径使用。尚未观察到青蒿素衍生物有抗药性。
