Case Management of Plasmodium falciparum Infection among Children Aged 5 Years or less and Survey of Antimalarial Resistance of Plasmodium falciparum in the Democratic Republic of Sao Tome and Principe

• Main Authors: Che-Ming Lin, 林哲民
• Other Authors: 蘇霩靄
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/38799217848489402874

碩士 === 國立臺灣大學 === 微生物學研究所 === 95 === We aimed to assess the efficacy of an antimalarial combination therapy with artesunate (A) and sulfadoxine/pyrimethamine (SP) for children aged less than 5 years (258 persons, 124 males and 134 females; median age, 37 months) who were inhabitants of selected farm villages and diagnosed with falciparum malaria; and to analyze the prevalence of SP resistant gene of P. falciparum and its incidence after treatment with SP in the Democratic Republic of San Tome and Principe. Treatment regimens were administered on a directly-observed-therapy basis. In the study, blood specimens were collected from children infected with malaria on day 0 (before the initiation of A/SP), day 1, day 2, day 3, day 7, day 14, day 21, and day 28 for microscopic examinations. The rate of parasitemia on day 3, day 7, day 14, day 21, and day 28 of antimalarial therapy was 7.87%, 5.51%, 2.81%, 6.1%, and 7.26%, respectively, on an as-treat analysis. The regimen was well tolerated. In addition, we designed primers specific to the DHFR and DHPS genes of P. falciparum for nested PCR；then, we purified the PCR products and sequence them. At baseline, we found that 61% of P. falciparum demonstrated intermediate-level resistance to pyrimethamine, 35% of P. falciparum low-level resistance to pyrimethanine, 12% of P. falciparum intermediate-level resistance to sufadoxine and 80% of P. falciparum low-level resistance to sulfadoxine. Furthermore, we used PCR-RFLP genotyping method to distinguish recrudescence from reinfection. We found that 35 of 59 children had reinfection；among the other 24 children we were not able to distinguish the two by this method. We concluded that A plus SP was effective as a antimalarial combination treatment for children aged less than 5 years who developed falciparum malaria in the Democratic Republic of San Tome and Principe. Prevalence of P. falciparum resistant to SP was high, other antimalarial combination regimens should be investigated.