Early parasite clearance following artemisinin-based combination therapy among Ugandan children with uncomplicated Plasmodium falciparum malaria

作者：Muhindo Mary K^*; Kakuru Abel; Jagannathan Prasanna; Talisuna Ambrose; Osilo Emmanuel; Orukan Francis; Arinaitwe Emmanuel; Tappero Jordan W; Kaharuza Frank; Kamya Moses R; Dorsey Grant

来源：Malaria Journal, 2014, 13(1): 32.

DOI：10.1186/1475-2875-13-32

• Malaria
• Plasmodium falciparum
• Artemisinin-based combination therapy
• Parasite clearance
• Artemether-lumefantrine
• Dihydroartemisin-piperaquine

Background: Artemisinin-based combination therapy (ACT) is widely recommended as first-line therapy for uncomplicated Plasmodium falciparum malaria worldwide. Artemisinin resistance has now been reported in Southeast Asia with a clinical phenotype manifested by slow parasite clearance. Although there are no reliable reports of artemisinin resistance in Africa, there is a need to better understand the dynamics of parasite clearance in African children treated with ACT in order to better detect the emergence of artemisinin resistance. %26lt;br%26gt;Methods: Data from a cohort of Ugandan children four to five years old, enrolled in a longitudinal, randomized, clinical trial comparing two leading ACT, artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP), were analysed. For all episodes of uncomplicated P. falciparum malaria over a 14-month period, daily blood smears were performed for three days following the initiation of therapy. Associations between pre-treatment variables of interest and persistent parasitaemia were estimated using multivariate, generalized, estimating equations with adjustment for repeated measures in the same patient. %26lt;br%26gt;Results: A total of 202 children were included, resulting in 416 episodes of malaria treated with AL and 354 episodes treated with DP. The prevalence of parasitaemia on days 1, 2, and 3 following initiation of therapy was 67.6, 5.6 and 0% in those treated with AL, and 52.2, 5.7 and 0.3% in those treated with DP. Independent risk factors for persistent parasitaemia on day 1 included treatment with AL vs DP (RR = 1.34, 95% CI 1.20-1.50, p %26lt; 0.001), having a temperature %26gt;= 38.0 degrees C vs %26lt;37.0 degrees C (RR = 1.19, 95% CI 1.05-1.35, p = 0.007) and having a parasite density %26gt;20,000/mu L vs %26lt;4,000/mu L (RR = 3.37, 95% CI 2.44-4.49, p %26lt; 0.001). Independent risk factors for having persistent parasitaemia on day 2 included elevated temperature, higher parasite density, and being HIV infected. %26lt;br%26gt;Conclusions: Among Ugandan children, parasite clearance following treatment with AL or DP was excellent with only one of 752 patients tested having a positive blood slide three days after initiation of therapy. The type of ACT given, pre-treatment temperature, pre-treatment parasite density and HIV status were associated with differences in persistent parasitaemia, one or two days following therapy.

• 出版日期2014-1-28