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primaquine clinical

Dhelio Pereira, André Daher, Graziela Zanini, Ivan Maia, Lais Fonseca, Luciana Pitta, Rosilene Ruffato, Paola Marchesini, Cor Jesus Fontes
BACKGROUND: Malaria remains a major public health problem, with half the world population at risk of contracting malaria. The effects of Plasmodium vivax on prosperity and longevity have been highlighted in several recent clinical case reports. The first line of vivax treatment drugs has seen no radical innovation for more than 60 years. This study introduces a subtle incremental innovation to vivax treatment: a chloroquine and primaquine co-blister. The co-blister includes a new chloroquine formulation incorporating coated tablets to mask the drug's bitter taste and user-friendly packaging containing tablets of each drug, which may improve patient adherence and facilitate the appropriate use of the drugs...
2016: Malaria Journal
Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Berit Aydin-Schmidt, Roland Gosling, Zul Premji, Bruno Mmbando, Anders Björkman, Andreas Mårtensson
BACKGROUND: The World Health Organization (WHO) recently recommended the addition of a single low-dose of the gametocytocidal drug primaquine (PQ) to artemisinin-based combination therapy (ACT) in low transmission settings as a component of pre-elimination or elimination programmes. However, it is unclear whether that influences the ACT cure rate. The study assessed treatment outcome of artemether-lumefantrine (AL) plus a single PQ dose (0.25 mg/kg) versus standard AL regimen for treatment of acute uncomplicated Plasmodium falciparum malaria in Tanzania...
2016: Malaria Journal
Mamadou A Diallo, Aida S Badiane, Khadim Diongue, Awa Deme, Naomi W Lucchi, Marie Gaye, Tolla Ndiaye, Mouhamadou Ndiaye, Louise K Sene, Abdoulaye Diop, Amy Gaye, Yaye D Ndiaye, Diama Samb, Mamadou S Yade, Omar Ndir, Venkatachalam Udhayakumar, Daouda Ndiaye
BACKGROUND: Plasmodium ovale is rarely described in Senegal. A case of clinical malaria due to P. ovale wallikeri in West Central of Senegal is reported. CASE: A 34-year-old male baker in Dakar, with no significant previous medical history, was admitted to a health clinic with fever and vomiting. Fever had been lasting for 4 days with peaks every 48 h. As monospecific Plasmodium falciparum HRP-2 RDT was negative, he was treated with antibiotics. However, owing to persisting symptoms, he was referred to the emergency unit of the Youssou Mbargane Diop Hospital, Dakar, Senegal...
2016: Malaria Journal
Georg Maschmeyer, Jannik Helweg-Larsen, Livio Pagano, Christine Robin, Catherine Cordonnier, Peter Schellongowski
The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice...
September 2016: Journal of Antimicrobial Chemotherapy
Suiane Negreiros, Samela Farias, Giselle Maria Rachid Viana, Sheila Akinyi Okoth, Stella M Chenet, Thayna Maria Holanda de Souza, Paola Marchesini, Venkatachalam Udhayakumar, Marinete Marins Povoa, Ana Carolina Faria E Silva Santelli, Alexandre Macedo de Oliveira
We evaluated the efficacy of chloroquine and primaquine on uncomplicated Plasmodium vivax malaria in Cruzeiro do Sul, Brazil, in 2014. Patients ≥ 5 years of age with either fever or history of fever, and laboratory-confirmed P. vivax monoinfection received chloroquine (total dose = 25 mg/kg) and primaquine (total dose = 3.5 mg/kg), and were followed up for 168 days (24 weeks). We used microsatellite genotyping to differentiate recurrent infections caused by heterologous parasites from those caused by homologous ones...
August 22, 2016: American Journal of Tropical Medicine and Hygiene
Sarah O'Neill, Susan Dierickx, Joseph Okebe, Edgard Dabira, Charlotte Gryseels, Umberto d'Alessandro, Koen Peeters Grietens
BACKGROUND: Clinical trials require high levels of participation and low drop-out rates to be successful. However, collecting blood samples from individuals recruited into clinical trials can be challenging when there is reticence about blood-taking. In addition to concerns regarding the feasibility of medical research, fears of 'blood-stealing' and 'blood-selling' have ethical implications related to cultural sensitivity and informed consent. This study explores anxieties around blood-taking during a malaria treatment trial in the Gambia...
2016: PloS One
Teresinha C Mesquita, Thamires G O Martin, Eduardo R Alves, Marcia B C Mello, Andreia F Nery, Luciano T Gomes, Cor Jesus F Fontes
Although serum lipids are known to be altered in Plasmodium falciparum-induced malaria, little is known about such changes due to Plasmodium vivax infection. This cohort study assessed serum concentrations of triglycerides, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) in 164 patients in the acute phase of malaria caused by P. vivax and characterized these changes in the convalescent phase after treatment with chloroquine and primaquine. Compared to reference values, serum total cholesterol, LDL, and HDL levels were lower and triglyceride levels were higher in the acute phase...
November 2016: Acta Tropica
Youn-Jung Kim, Chang Hwan Sohn, Seung Mok Ryoo, Shin Ahn, Dong Woo Seo, Yoon-Seon Lee, Jae Ho Lee, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
CONTEXT: Acquired methemoglobinemia is a potentially fatal condition that leads to tissue hypoxia. Although the clinical features of methemoglobinemia depend on the methemoglobin levels, the clinical course would differ depending on the causative agents. OBJECTIVE: We attempted to clarify this issue by comparing the clinical course of methemoglobinemia caused by dapsone and that caused by other toxic agents. MATERIALS AND METHODS: A retrospective case-control study was performed...
August 2016: Clinical Toxicology
Kavitha Saravu, Rishikesh Kumar, Herikudru Ashok, Premananda Kundapura, Veena Kamath, Asha Kamath, Chiranjay Mukhopadhyay
BACKGROUND: Several reports of chloroquine treatment failure and resistance in Plasmodium vivax malaria from Southeast Asian countries have been published. Present study was undertaken to assess the efficacy of chloroquine-primaquine (CQ-PQ) combined regimen for the treatment of P. vivax malaria patients who were catered by the selected primary health centres (PHCs) of Udupi taluk, Udupi district, Karnataka, India. METHOD: Five PHCs were selected within Udupi taluk based on probability proportional to size...
2016: PloS One
Wahib M Atroosh, Hesham M Al-Mekhlafi, Georges Snounou, Adel Al-Jasari, Hany Sady, Nabil A Nasr, Yee-Ling Lau, Johari Surin
BACKGROUND: In Yemen, artesunate plus sulfadoxine-pyrimethamine (AS + SP) has been used as first-line treatment for uncomplicated falciparum malaria, which accounts for about 99 % of malaria cases. There is evidence that resistance to SP is increasing, with potential negative impact on efficacy, and in particular on curbing transmission. This study aims: (a) to evaluate the therapeutic efficacy of AS + SP treatment for uncomplicated falciparum malaria in Yemen; (b) to investigate the frequency of mutations in Plasmodium falciparum genes associated with resistance to AS (Kelch 13 propeller domain, pfK13) and SP (dihydrofolate reductase, pfdhfr, and dihydropteroate synthase, pfdhps); and (c) to assess the adequacy of this ACT to clear gametocytes...
2016: Malaria Journal
Hsiao-Han Chang, Elamaran Meibalan, Justin Zelin, Rachel Daniels, Alice C Eziefula, Evan C Meyer, Fitsum Tadesse, Lynn Grignard, Regina C Joice, Chris Drakeley, Dyann F Wirth, Sarah K Volkman, Caroline Buckee, Teun Bousema, Matthias Marti
Artemisinin resistance is rapidly spreading in Southeast Asia. The efficacy of artemisinin-combination therapy (ACT) continues to be excellent across Africa. We performed parasite transcriptional profiling and genotyping on samples from an antimalarial treatment trial in Uganda. We used qRT-PCR and genotyping to characterize residual circulating parasite populations after treatment with either ACT or ACT-primaquine. Transcripts suggestive of circulating ring stage parasites were present after treatment at a prevalence of >25% until at least 14 days post initiation of treatment...
2016: Scientific Reports
Xiannu Jin, Brittney Potter, Thu-Lan Luong, Jennifer Nelson, Chau Vuong, Corttney Potter, Lisa Xie, Jing Zhang, Ping Zhang, Jason Sousa, Qigui Li, Brandon S Pybus, Mara Kreishman-Deitrick, Mark Hickman, Philip L Smith, Robert Paris, Gregory Reichard, Sean R Marcsisin
BACKGROUND: The liver-stage anti-malarial activity of primaquine and other 8-aminoquinoline molecules has been linked to bio-activation through CYP 2D6 metabolism. Factors such as CYP 2D6 poor metabolizer status and/or co-administration of drugs that inhibit/interact with CYP 2D6 could alter the pharmacological properties of primaquine. METHODS: In the present study, the inhibitory potential of the selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) classes of antidepressants for CYP 2D6-mediated primaquine metabolism was assessed using in vitro drug metabolism and in vivo pharmacological assays...
2016: Malaria Journal
Sonam Wangchuk, Tobgyel Drukpa, Kinley Penjor, Tashi Peldon, Yeshey Dorjey, Kunzang Dorji, Vishal Chhetri, Hidayat Trimarsanto, Sheren To, Amanda Murphy, Lorenz von Seidlein, Ric N Price, Kamala Thriemer, Sarah Auburn
BACKGROUND: Bhutan has made substantial progress in reducing malaria incidence. The national guidelines recommend chloroquine (CQ) and primaquine (PQ) for radical cure of uncomplicated Plasmodium vivax, but the local efficacy has not been assessed. The impact of cases imported from India on the genetic make-up of the local vivax populations is currently unknown. METHODS: Patients over 4 years of age with uncomplicated P. vivax mono-infection were enrolled into a clinical efficacy study and molecular survey...
2016: Malaria Journal
Benedikt Ley, Mohammad Shafiul Alam, Kamala Thriemer, Mohammad Sharif Hossain, Mohammad Golam Kibria, Sarah Auburn, Eugenie Poirot, Ric N Price, Wasif Ali Khan
BACKGROUND: The Bangladeshi national treatment guidelines for uncomplicated malaria follow WHO recommendations but without G6PD testing prior to primaquine administration. A prospective observational study was conducted to assess the efficacy of the current antimalarial policy. METHODS: Patients with uncomplicated malaria, confirmed by microscopy, attending a health care facility in the Chittagong Hill Tracts, Bangladesh, were treated with artemether-lumefantrine (days 0-2) plus single dose primaquine (0...
2016: PloS One
Thomas J Peto, Sabine E Kloprogge, Rupam Tripura, Chea Nguon, Nou Sanann, Sovann Yok, Chhouen Heng, Cholrawee Promnarate, Jeremy Chalk, Ngak Song, Sue J Lee, Yoel Lubell, Mehul Dhorda, Mallika Imwong, Nicholas J White, Lorenz von Seidlein, Arjen Dondorp
BACKGROUND: Treatment of the sub-clinical reservoir of malaria, which may maintain transmission, could be an important component of elimination strategies. The reliable detection of asymptomatic infections with low levels of parasitaemia requires high-volume quantitative polymerase chain reaction (uPCR), which is impractical to conduct on a large scale. It is unknown to what extent sub-clinical parasitaemias originate from recent or older clinical episodes. This study explored the association between clinical history of malaria and subsequent sub-clinical parasitaemia...
2016: Malaria Journal
Matthew J Grigg, Timothy William, Jayaram Menon, Bridget E Barber, Christopher S Wilkes, Giri S Rajahram, Michael D Edstein, Sarah Auburn, Ric N Price, Tsin W Yeo, Nicholas M Anstey
BACKGROUND: Chloroquine (CQ)-resistant Plasmodium vivax is increasingly reported throughout southeast Asia. The efficacy of CQ and alternative artemisinin combination therapies (ACTs) for vivax malaria in Malaysia is unknown. METHODS: A randomized, controlled trial of CQ vs artesunate-mefloquine (AS-MQ) for uncomplicated vivax malaria was conducted in 3 district hospitals in Sabah, Malaysia. Primaquine was administered on day 28. The primary outcome was the cumulative risk of treatment failure by day 28 by Kaplan-Meier analysis...
June 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Pius S Fasinu, Bharathi Avula, Babu L Tekwani, N P Dhammika Nanayakkara, Yan-Hong Wang, H M T Bandara Herath, James D McChesney, Gregory A Reichard, Sean R Marcsisin, Mahmoud A Elsohly, Shabana I Khan, Ikhlas A Khan, Larry A Walker
BACKGROUND: The clinical utility of primaquine (PQ), used as a racemic mixture of two enantiomers, is limited due to metabolism-linked hemolytic toxicity in individuals with genetic deficiency in glucose-6-phosphate dehydrogenase. The current study investigated differential metabolism of PQ enantiomers in light of the suggestions that toxicity and efficacy might be largely enantioselective. METHODS: Stable isotope (13)C-labelled primaquine and its two enantiomers (+)-PQ, (-)-PQ were separately incubated with cryopreserved human hepatocytes...
2016: Malaria Journal
Joachim Richter, Gabriele Franken, Martha C Holtfreter, Susanne Walter, Alfons Labisch, Heinz Mehlhorn
Malaria recurrences after an initially successful therapy and malarial fever occurring a long time after infection are well-known problems in malariology. Currently, two distinct types of malaria recurrences are defined: recrudescence and relapse. A recrudescence is thought to originate from circulating Plasmodium blood stages which do not cause fever before a certain level of a microscopically detectable parasitemia is reached. Contrary, a relapse is thought to originate from quiescent intracellular hepatic parasite stages called hypnozoites...
June 2016: Parasitology Research
Kyaw Myo Tun, Atthanee Jeeyapant, Mallika Imwong, Min Thein, Sai Soe Moe Aung, Tin Maung Hlaing, Prayoon Yuentrakul, Cholrawee Promnarate, Mehul Dhorda, Charles J Woodrow, Arjen M Dondorp, Elizabeth A Ashley, Frank M Smithuis, Nicholas J White, Nicholas P J Day
BACKGROUND: Artemisinin resistance in Plasmodium falciparum extends across Southeast Asia where it is associated with worsening partner drug resistance and a decline in the efficacy of frontline artemisinin-based combination therapy. Dihydroartemisinin-piperaquine (DP) is an essential component of preventive and curative treatment in the region, but its therapeutic efficacy has fallen in Cambodia. METHODS: A prospective clinical and parasitological evaluation of DP was conducted at two sites in Upper Myanmar between August 2013 and December 2014, enrolling 116 patients with acute uncomplicated falciparum malaria...
2016: Malaria Journal
Germana Bancone, Nongnud Chowwiwat, Raweewan Somsakchaicharoen, Lalita Poodpanya, Paw Khu Moo, Gornpan Gornsawun, Ladda Kajeechiwa, May Myo Thwin, Santisuk Rakthinthong, Suphak Nosten, Suradet Thinraow, Slight Naw Nyo, Clare L Ling, Jacher Wiladphaingern, Naw Lily Kiricharoen, Kerryn A Moore, Nicholas J White, Francois Nosten
BACKGROUND: Primaquine is the only drug consistently effective against mature gametocytes of Plasmodium falciparum. The transmission blocking dose of primaquine previously recommended was 0.75 mg/kg (adult dose 45 mg) but its deployment was limited because of concerns over haemolytic effects in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency is an inherited X-linked enzymatic defect that affects an estimated 400 million people around the world with high frequencies (15-20%) in populations living in malarious areas...
2016: PloS One
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