Parasites, Hosts and Diseases

The Korea Society for Parasitology and Tropical Medicine (대한기생충학·열대의학회)
권호 표지
DOI QR코드

DOI QR Code

Therapeutic Assessment of Primaquine for Radical Cure of Plasmodium vivax Malaria at Primary and Tertiary Care Centres in Southwestern India

  • Received : 2016.07.05
  • Accepted : 2016.09.27
  • Published : 2016.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Acquaintance is scanty on primaquine (PQ) efficacy and Plasmodium vivax recurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to prevent P. vivax recurrence. Microscopically, aparasitemic adults (${\geq}18years$) after acute vivax malaria on day 28 were re-enrolled into 15 months' long follow-up study. A peripheral blood smear examination was performed with participants at every 1-2 month interval. A nested PCR test was performed to confirm the mono-infection with P. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2-5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24-5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved that P. vivax mono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.

Keywords

References

  1. WHO. World Malaria Report 2013. Geneva, Switzerland. World Health Organization. 2013.
  2. Rishikesh K, Saravu K. Primaquine treatment and relapse in Plasmodium vivax malaria. Pathog Glob Health 2016; 110: 1-8. https://doi.org/10.1080/20477724.2015.1133033
  3. White NJ. Determinants of relapse periodicity in Plasmodium vivax malaria. Malar J 2011; 10: 297. https://doi.org/10.1186/1475-2875-10-297
  4. WHO. World Malaria Report 2014. Geneva, Switzerland. World Health Organization. 2014.
  5. Directorate of National Vector Borne Disease Control Programme. National Drug Policy on Malaria. 22-Shamnath Marg, Delhi-110054: Directorate General of Health Services: Ministry of Health and Family Welfare. 2013.
  6. Srivastava HC, Sharma SK, Bhatt RM, Sharma VP. Studies on Plasmodium vivax relapse pattern in Kheda district, Gujarat. Indian J Malariol 1996; 33: 173-179.
  7. Adak T, Sharma VP, Orlov VS. Studies on the Plasmodium vivax relapse pattern in Delhi, India. Am J Trop Med Hyg 1998; 59: 175-179. https://doi.org/10.4269/ajtmh.1998.59.175
  8. Adak T, Valecha N, Sharma VP. Plasmodium vivax polymorphism in a clinical drug trial. Clin Diagn Lab Immunol 2001; 8: 891-894.
  9. Gogtay NJ, Desai S, Kadam VS, Kamtekar KD, Dalvi SS, Kshirsagar NA. Relapse pattern of Plasmodium vivax in Mumbai: a study of 283 cases of vivax malaria. J Assoc Physicians India 2000; 48: 1085-1086.
  10. Kim JR, Nandy A, Maji AK, Addy M, Dondorp AM, Day NP, Pukrittayakamee S, White NJ, Imwong M. Genotyping of Plasmodium vivax reveals both short and long latency relapse patterns in Kolkata. PLoS One 2012; 7: e39645. https://doi.org/10.1371/journal.pone.0039645
  11. Gogtay N, Desai S, Kamtekar KD, Kadam VS, Dalvi SS, Kshirsagar NA. Efficacies of 5-and-14-day primaquine regimens in the prevention of relapses in Plasmodium vivax infections. Ann Trop Med Parasitol 1999; 93: 809-812.
  12. Sinha S, Dua VK, Sharma VP. Efficacy of 5 day radical treatment of primaquine in Plasmodium vivax cases at the BHEL Industrial Complex, Hardwar (UP). Indian J Malariol 1989; 26: 83-86.
  13. Rishikesh K, Kamath A, Hande MH, Vidyasagar S, Acharya RV, Acharya V, Belle J, Shastry AB, Saravu K. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India. Malar J 2015; 14: 310. https://doi.org/10.1186/s12936-015-0824-y
  14. Saravu K, Kumar R, Ashok H, Kundapura P, Kamath V, Kamath A, Mukhopadhyay C. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from primary care centres in southwestern India. PLoS One 2016; 11: e0157666. https://doi.org/10.1371/journal.pone.0157666
  15. World Health Organization. Point-of-care G6PD testing to support safe use of primaquine for the treatment of vivax malaria. WHO Evidence Review Group meeting report. In Malaria Policy Advisory Committee Meeting. Geneva, Switzerland. WHO/UNAIDS Building. 2015.
  16. Rishikesh K, Madivala SK, Prabhu P, Kamath A, Ashok H, Vidyasagar S, Shastry AB, Saravu K. Surmised total leucocyte counts miscalculate the parasite index of Plasmodium vivax malaria patients of tertiary and primary care settings in South-Western India. Malar J 2015; 14: 163. https://doi.org/10.1186/s12936-015-0669-4
  17. World Health Organization. A practical handbook--Management of severe malaria. 3rd ed. Geneva, Switzerland. World Health Organization. 2012.
  18. Snounou G, Viriyakosol S, Zhu XP, Jarra W, Pinheiro L, do Rosario VE, Thaithong S, Brown KN. High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction. Mol Biochem Parasitol 1993; 61: 315-320. https://doi.org/10.1016/0166-6851(93)90077-B
  19. Saravu K, Rishikesh K, Parikh CR. Risk factors and outcomes stratified by severity of acute kidney injury in malaria. PLoS One 2014; 9: e90419. https://doi.org/10.1371/journal.pone.0090419
  20. Saravu K, Rishikesh K, Kamath A, Shastry AB. Severity in Plasmodium vivax malaria claiming global vigilance and exploration-a tertiary care centre-based cohort study. Malar J 2014; 13: 304. https://doi.org/10.1186/1475-2875-13-304
  21. Saravu K, Rishikesh K, Kamath A. Determinants of mortality, intensive care requirement and prolonged hospitalization in malaria-a tertiary care hospital based cohort study from South-Western India. Malar J 2014; 13: 370. https://doi.org/10.1186/1475-2875-13-370
  22. Doolan DL, Dobano C, Baird JK. Acquired immunity to malaria. Clin Microbiol Rev 2009; 22: 13-36. https://doi.org/10.1128/CMR.00025-08
  23. Rishikesh K, Kamath A, Hande MH, Vidyasagar S, Acharya RV, Acharya V, Belle J, Shastry AB, Saravu K. Therapeutic assessment of chloroquine-primaquine combined regimen in adult cohort of Plasmodium vivax malaria from a tertiary care hospital in southwestern India. Malar J 2015; 14: 310. https://doi.org/10.1186/s12936-015-0824-y

Cited by

  1. A pilot randomized controlled trial to compare the effectiveness of two 14-day primaquine regimens for the radical cure of vivax malaria in South India vol.17, pp.None, 2018, https://doi.org/10.1186/s12936-018-2472-5
  2. Efficacy of Primaquine in Preventing Short- and Long-Latency Plasmodium vivax Relapses in Nepal vol.220, pp.3, 2016, https://doi.org/10.1093/infdis/jiz126
  3. Population Pharmacokinetics of Primaquine in the Korean Population vol.13, pp.5, 2016, https://doi.org/10.3390/pharmaceutics13050652