Failure of Supervised Chloroquine and Primaquine Regimen for the Treatment ofPlasmodium vivaxin the Peruvian Amazon

[摘要] The widespread use of primaquine (PQ) and chloroquine (CQ), together, may be responsible for the relatively few, isolated cases of chloroquine-resistantP. vivax(CQRPV) that have been reported from South America. We report here a case ofP. vivaxfrom the Amazon Basin of Peru that recurred against normally therapeutic blood levels of CQ. Four out of 540 patients treated with combination CQ and PQ had a symptomatic recurrence ofP. vivaxparasitemia within 35 days of treatment initiation, possibly indicating CQ failure. Whole blood total CQ level for one of these four subjects was 95 ng/ml on the day of recurrence. Based on published criteria that delineate CQRPV as aP. vivaxparasitemia, either recrudescence or relapse, that appears against CQ blood levels >100 ng/mL, we document the occurrence of aP. vivaxstrain in Peru that had unusually high tolerance to the synergistic combination therapy of CQ + PQ that normally works quite well.

[学科分类] 传染病学