Parasites, Hosts and Diseases

"recurrence"

Case Reports

Four Times of Relapse of Plasmodium vivax Malaria Despite Primaquine Treatment in a Patient with Impaired Cytochrome P450 2D6 Function: Sungim Choi, Heun Choi, Seong Yeon Park, Yee Gyung Kwak, Je Eun Song, So Youn Shin, Ji Hyeon Baek, Hyun-IL Shin, Hong Sang Oh, Yong Chan Kim, Joon-Sup Yeom, Jin-Hee Han, Min Jae Kim; Korean J Parasitol 2022;60(1):39-43.
Published online February 23, 2022; DOI: https://doi.org/10.3347/kjp.2022.60.1.39

Plasmodium vivax exhibits dormant liver-stage parasites, called hypnozoites, which can cause relapse of malaria. The only drug currently used for eliminating hypnozoites is primaquine. The antimalarial properties of primaquine are dependent on the production of oxidized metabolites by the cytochrome P450 isoenzyme 2D6 (CYP2D6). Reduced primaquine metabolism may be related to P. vivax relapses. We describe a case of 4 episodes of recurrence of vivax malaria in a patient with decreased CYP2D6 function. The patient was 52-year-old male with body weight of 52 kg. He received total gastrectomy and splenectomy 7 months before the first episode and was under chemotherapy for the gastric cancer. The first episode occurred in March 2019 and each episode had intervals of 34, 41, and 97 days, respectively. At the first and second episodes, primaquine was administered as 15 mg for 14 days. The primaquine dose was increased with 30 mg for 14 days at the third and fourth episodes. Seven gene sequences of P. vivax were analyzed and revealed totally identical for all the 4 samples. The CYP2D6 genotype was analyzed and intermediate metabolizer phenotype with decreased function was identified.

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A toxoplasmic uveitis case of a 60-year-old male in Korea: Min-Ho Kim, Yeun-Kyoung Choi, Yun-Kyu Park, Ho-Woo Nam; Korean J Parasitol 2000;38(1):29-31.
Published online March 31, 2000; DOI: https://doi.org/10.3347/kjp.2000.38.1.29

Abstract
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A toxoplasmic uveitis case was reported on the focus of impairment of pathological findings and serological antibody titers after chemotherapy. A chief complaint of a 60-year-old male was a decreased and blurred vision in his right eye for 2 weeks after experiencing tremendous stress and fatigue. A steroid therapy for 3 weeks was not effective and the retinal lesion became necrotic. Anti-Toxoplasma gondii antibody titer was checked to be a strong positive by both ELISA and indirect latex agglutination assay (ILA). He was treated with Fansidar F for 8 weeks. His vision improved as the necrotic lesion healed by scarring, but the antibody titers still remained very high without any signs of negative conversion. It is suggested to be a recurrent case of the past asymptomatic infection by presumed immune suppression caused by excessive stress.

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