Korean J Parasitol.  2016 Dec;54(6):733-742. 10.3347/kjp.2016.54.6.733.

Therapeutic Assessment of Primaquine for Radical Cure of Plasmodium vivax Malaria at Primary and Tertiary Care Centres in Southwestern India

Affiliations
  • 1Department of Medicine, Kasturba Medical College, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India. kavithasaravu@gmail.com
  • 2Department of Statistics, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.
  • 3Manipal McGill Center for Infectious Diseases, Manipal University, Madhav Nagar, Manipal, Karnataka, 576104, India.

Abstract

Acquaintance is scanty on primaquine (PQ) efficacy and Plasmodium vivax recurrence in Udupi district, Karnataka, India. We assessed the efficacy of 14 days PQ regimen (0.25 mg/kg/day) to prevent P. vivax recurrence. Microscopically, aparasitemic adults (≥18 years) after acute vivax malaria on day 28 were re-enrolled into 15 months' long follow-up study. A peripheral blood smear examination was performed with participants at every 1-2 month interval. A nested PCR test was performed to confirm the mono-infection with P. vivax. Of 114 participants, 28 (24.6%) recurred subsequently. The median (IQR) duration of the first recurrence was 3.1 (2.2-5.8) months which ranged from 1.2 to 15.1 months, including initial 28 days. Participants with history of vivax malaria had significantly higher risk of recurrence, with hazard ratio (HR) (95% CI) of 2.62 (1.24-5.54) (P=0.012). Severity of disease (11.4%, 13/114) was not associated (P=1.00) with recurrence. Of 28 recurrence cases, the nPCR proved that P. vivax mono-infection recurrence rate was at least 72.7% (16/22) at first recurrence. In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.

Keyword

Plasmodium vivax; malaria; anti-malarial; treatment failure; relapse; primaquine

MeSH Terms

Adult
Follow-Up Studies
Humans
India*
Malaria
Malaria, Vivax*
Plasmodium vivax*
Plasmodium*
Polymerase Chain Reaction
Primaquine*
Recurrence
Tertiary Healthcare*
Treatment Failure
Primaquine
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