Sunday, 23 December 2012

MALARIA: therapeutic efficacy of chloroquine

In vivo therapeutic efficacy of chloroquine alone or in combination with primaquine in vivax malaria in Kolkata, West Bengal, India and polymorphism inpvmdr1 and pvcrt-0 genes

  1. Ardhendu K. Majia,*
+Author Affiliations
  1. aCalcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata 700 073, India
  2. bDepartment of Health & Family Welfare, Government of West Bengal, Swasthya Bhawan, Salt Lake City, Kolkata-700092, India


Plasmodium vivax malaria though benign, has now become a matter of concern due to recent reports of life threatening severity and development of parasite resistance against different antimalarial drugs. The magnitude of the problem is still undetermined. The present study was undertaken to determine the in vivoefficacy of chloroquine and chloroquine plus primaquine in P. vivax malaria in Kolkata and polymorphisms in pvmdr1 and pvcrt-0 genes.
A total of 250 patients with P. vivax monoinfection were recruited and randomised into two groups A and B, treated with chloroquine and chloroquine plus primaquine respectively and followed up for 42 days as per WHO protocol (2009). Data were analysed using per protocol analyses. We assessed polymorphisms of pvmdr1 and pvcrt-0 genes by DNA sequencing method.
Out of 250 recruited patients, 204 cases completed 42 days follow up period, 101 in group A and 103 in group B. In group A, PCR uncorrected efficacy of CQ was 99% (95% CI 0.944-1.00) and in group B all cases were classified as ACPR. Day 3 positivity was observed in 11 (5.3%) cases. No specific mutation pattern was recorded in pvcrt-0 gene. Eight non-synonymous mutations were found inpvmdr1 gene, of which three were new. Y976F mutation was not detected in any isolate.
Chloroquine either alone or in combination with primaquine is still effective against P. vivax malaria in the study area.

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