Biology Reference
In-Depth Information
settings, then this new primaquine regimen would be a major advance in
malaria treatment improving adherence to and thus the effectiveness of
anti-relapse therapy. Alternatively, patient education campaigns and even
routine direct observation of therapy may also be beneficial and warrant
further development.
The development of a reliable and safe radical cure of P. vivax that can be
pragmatically deployed in endemic country settings is one of the top priorities
of vivax therapeutics. Once achieved, novel deployment strategies must then
be studied to target the transmission cycle and reduce the overall burden of
disease. Individuals infected with hypnozoites and/or undetectable or asymp-
tomatic asexual parasitemia, constitute a major reservoir of infection. This
is highlighted by observations of high rates of P. vivax recurrence following
treatment for supposedly pure P. falciparum infections, presumably from occult
infections ( Douglas et al., 2011 ). This argues for the provision of effective
anti-hypnozoite treatment to all patients with malaria in co-endemic regions
rather than just those with confirmed P. vivax infections ( Douglas et al., 2011 ).
7. TREATMENT OF SEVERE AND COMPLICATED VIVAX
MALARIA
Severe vivax malaria, in the absence of mixed P. falciparum infection,
has been reported with increasing frequency from India, Brazil, Venezuela,
Afghanistan, Pakistan, India, Indonesia, and Papua New Guinea ( Poespo-
prodjo et al., 2009 ; Islam and Qamruddin, 1995 ; Munteis et al., 1997 ; Torres
et al., 1997 ; Perren et al., 1998 ; Pukrittayakamee et al., 1998 ; Carlini et al.,
1999 ; Curlin et al., 1999 ; Tanios et al., 2001 ; Lawn et al., 2003 ; Habib and
Singh, 2004 ; Kochar et al., 2005 ; Kotwal et al., 2005 ; Lomar et al., 2005 ;
Saleri et al., 2006 ; Agarwal et al., 2007 ; Kumar et al., 2007 ; Maguire et al.,
2007 ; Price et al., 2007a ; Barcus et al., 2007 ; Genton et al., 2008 ; Manning
et al., 2011 ; Tjitra et al., 2008 ; Nurleila et al., 2012 ; Shaikh et al., 2012 ).
The most frequent manifestations are severe anaemia and acute respira-
tory distress. Less commonly, cerebral malaria, kidney injury, shock, and
coagulopathy have also been reported. Although there have been no pro-
spective clinical trials, severe vivax malaria has been successfully managed
with various regimens including oral or intravenous quinine, intravenous
artesunate, chloroquine, quinidine, quinine plus doxycycline, mefloquine,
and artemether plus chloroquine ( Genton et al., 2008 ). Until controlled
clinical trials are conducted, severe non-falciparum malaria should be
managed similarly to severe falciparum malaria in intensive care settings
 
Search WWH ::




Custom Search