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

• Kumar R
• Guddattu V
• Saravu K

• KMID: 2367414
• DOI: http://doi.org/10.3347/kjp.2016.54.6.733

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