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"Shigeyuki Kano"

Brief Communication

Primaquine Administration after Falciparum Malaria Treatment in Malaria Hypoendemic Areas with High Incidence of Falciparum and Vivax Mixed Infection: Pros and Cons
Polrat Wilairatana, Noppadon Tangpukdee, Shigeyuki Kano, Srivicha Krudsood
Korean J Parasitol 2010;48(2):175-177.
Published online June 17, 2010
DOI: https://doi.org/10.3347/kjp.2010.48.2.175

Mixed infections of Plasmodium falciparum and Plasmodium vivax is high (~30%) in some malaria hypoendemic areas where the patients present with P. falciparum malaria diagnosed by microscopy. Conventional treatment of P. falciparum with concurrent chloroquine and 14 days of primaquine for all falciparum malaria patients may be useful in areas where mixed falciparum and vivax infections are high and common and also with mild or moderate G6PD deficiency in the population even with or without subpatent vivax mixed infection. It will be possibly cost-effective to reduce subsequent vivax illness if the patients have mixed vivax infection. Further study to prove this hypothesis may be warranted.

Citations

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  • Impact of enhanced malaria control on the competition between Plasmodium falciparum and Plasmodium vivax in India
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Original Articles
Gametocyte Clearance in Uncomplicated and Severe Plasmodium falciparum Malaria after Artesunate-Mefloquine Treatment in Thailand
Noppadon Tangpukdee, Srivicha Krudsood, Sriripun Srivilairit, Nanthaporn Phophak, Putza Chonsawat, Wimon Yanpanich, Shigeyuki Kano, Polrat Wilairatana
Korean J Parasitol 2008;46(2):65-70.
Published online June 20, 2008
DOI: https://doi.org/10.3347/kjp.2008.46.2.65

Artemisinin-based combination therapy (ACT) is currently promoted as a strategy for treating both uncomplicated and severe falciparum malaria, targeting asexual blood-stage Plasmodium falciparum parasites. However, the effect of ACT on sexual-stage parasites remains controversial. To determine the clearance of sexual-stage P. falciparum parasites from 342 uncomplicated, and 217 severe, adult malaria cases, we reviewed and followed peripheral blood sexual-stage parasites for 4 wk after starting ACT. All patients presented with both asexual and sexual stage parasites on admission, and were treated with artesunate-mefloquine as the standard regimen. The results showed that all patients were asymptomatic and negative for asexual forms before discharge from hospital. The percentages of uncomplicated malaria patients positive for gametocytes on days 3, 7, 14, 21, and 28 were 41.5, 13.1, 3.8, 2.0, and 2.0%, while the percentages of gametocyte positive severe malaria patients on days 3, 7, 14, 21, and 28 were 33.6, 8.2, 2.7, 0.9, and 0.9%, respectively. Although all patients were negative for asexual parasites by day 7 after completion of the artesunate-mefloquine course, gametocytemia persisted in some patients. Thus, a gametocytocidal drug, e.g., primaquine, may be useful in combination with an artesunate-mefloquine regimen to clear gametocytes, so blocking transmission more effectively than artesunate alone, in malaria transmission areas.

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Clinical efficacy of chloroquine versus artemether-lumefantrine for Plasmodium vivax treatment in Thailand
Srivicha Krudsood, Noppadon Tangpukdee, Sant Muangnoicharoen, Vipa Thanachartwet, Nutthanej Luplertlop, Siripan Srivilairit, Polrat Wilairatana, Shigeyuki Kano, Pascal Ringwald, Sornchai Looareesuwan
Korean J Parasitol 2007;45(2):111-114.
Published online June 20, 2007
DOI: https://doi.org/10.3347/kjp.2007.45.2.111

Chloroquine remains the drug of choice for the treatment of vivax malaria in Thailand. Mixed infections of falciparum and vivax malaria are also common in South-East Asia. Laboratory confirmation of malaria species is not generally available. This study aimed to find alternative regimens for treating both malaria species by using falciparum antimalarial drugs. From June 2004 to May 2005, 98 patients with Plasmodium vivax were randomly treated with either artemether-lumefantrine (n = 47) or chloroquine (n = 51). Both treatments were followed by 15 mg of primaquine over 14 days. Adverse events and clinical and parasitological outcomes were recorded and revealed similar in both groups. The cure rate was 97.4% for the artemether-lumefantrine treated group and 100% for the chloroquine treated group. We concluded that the combination of artemether-lumefantrine and primaquine was well tolerated, as effective as chloroquine and primaquine, and can be an alternative regimen for treatment of vivax malaria especially in the event that a mixed infection of falciparum and vivax malaria could not be ruled out.

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Minor liver profile dysfunctions in Plasmodium vivax, P. malariae and P. ovale patients and normalization after treatment
Noppadon Tangpukdee, Vipa Thanachartwet, Srivicha Krudsood, Nutthanej Luplertlop, Karnchana Pornpininworakij, Kobsiri Chalermrut, Sasikarn Phokham, Shigeyuki Kano, Sornchai Looareesuwan, Polrat Wilairatana
Korean J Parasitol 2006;44(4):295-302.
Published online December 20, 2006
DOI: https://doi.org/10.3347/kjp.2006.44.4.295

Liver function tests were performed in 61 vivax, 54 malariae and 15 ovale malaria patients who were admitted to Bangkok Hospital for Tropical Diseases between 2001 and 2004. The
objective
of the study was to evaluate changes in hepatic biochemical indices before and after treatment with artemisinin derivatives. On admission and prior to treatment, hepatic dysfunction was found among the 3 groups. Serum liver function tests and physical examinations were performed weekly during the 28-day follow-up period. Initially elevated serum bilirubin and diminished albumin returned to normal within 2 weeks of treatment. Serum alkaline phosphatase and aminotransferases returned to within normal limits within 3 weeks. We conclude that patients with Plasmodium vivax, P. malariae and P. ovale infections had slightly elevated serum bilirubin, aminotransferase and alkaline phosphatase levels, and hypoalbuminemia. These minor abnormalities returned to normal within a few weeks after treatment with therapies based on artemisinin derivatives.

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