aCalcutta School of Tropical Medicine, 108, C. R. Avenue, Kolkata 700 073, India
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 againstP. vivaxmalaria in the study area.
After service in the British SAS Regiment the author became a physician and then an orthopaedic surgeon.
He has held professorial positions in Canada, Vietnam and the United States, practiced and taught orthopaedic surgery in three continents and in several wars.
He has extensive experience as an expert witness in court. Somewhere along the way, time was found to operate a four hundred acre mixed farm, a one hundred seat restaurant and to obtain a licence as a flying instructor.
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