Plasmodium vivax infection treatment

Mefloquine, a fluorinated derivative of 4-quinoline methanol, is a product of the US Army s antimalarial research program. It is active against chloroquine-resistant Plasmodium falciparum, and has an excellent schizonti-cidal effect in the blood in experimentally induced Plasmodium vivax infections in volunteers. It is not gametocidal. P. vivax infections can persist after successful treatment of the falciparum infection with other drugs the fact that mefloquine is effective against both organisms is thus of practical importance (SEDA-13, 808). 

Malaria is transmitted by the bite of an infected female Anopheles mosquito, one of the few species of the insect capable of carrying the human malaria parasite. The responsible protozoa ate from the genus P/asmodium of which only four of some 100 species can cause the disease in humans. The remaining species affect rodents, reptiles, monkeys, birds, and Hvestock. The species that infect humans are P/asmodium falciparum Plasmodium vivax Plasmodium malariae and Plasmodium ovale. Note that concomitant multiple malaria infections are commonly seen in endemic areas, a phenomenon that further compHcates choice of treatment. 

Hydroxychloroquine sulfate is a 4-aminoquinoline compound that interferes with parasitic nucleoprotein (DNA/ RNA) synthesis and parasite growth or causes lysis of parasite or infected erythrocytes. In rheumatoid arthritis, it may suppress formation of antigens responsible for symptom-producing hypersensitivity reactions. It is indicated for prophylaxis and treatment of acute attacks of malaria caused by Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, and susceptible strains of Plasmodium falciparum. It is also used for treatment of chronic discoid and systemic lupus erythematosus (SLE) and acute or chronic rheumatoid arthritis in patients not responding to other therapies. 

Clinical malaria is characterised by periodic fever, which follows the lysis of infected erythrocytes, and caused mainly by the induction of cytokines interleukin-1 and tumour necrosis factor. P. falciparum infection can have serious effects, for example anaemia, cerebral complications (from coma to convulsions), hypoglycaemia and glomerulonephritis. The disease is most serious in the non-immune, including children, pregnant women and tourists. Humans in endemic areas, who have survived an attack of malaria, are semi-immune and disease can be characterised by headache and mild fever. Infection by the other species of Plasmodium is normally self-limiting although relapses may occur, particularly in P. vivax infections. The species of parasite and the age and immune status of the patient are important in considerations of treatment and interpretation of the effects of all medicines. 

Plasmodium vivax (benign tertian) is the most prevaient form of malaria. It has an incubation period of 1 to 4 weeks (average, 2 weeks). This form of maiaria can cause spleen rupture and anemia. Reiapses (renewed manifestations of erythrocytic infection) can occur. This results from the periodic reiease of dormant parasites (hypnozoites) from the iiver cells. The erythrocytic forms generaiiy are considered to be susceptibie to treatment. 

Douglas and coworkers [171] have strongly recommended artemisinin-based combination therapies to eliminate malaria, which is used to treat P. falciparum malaria even when most blood-stage infections caused by Plasmodium vivax still respond to chloroquine treatment, a chloroquine-resistant P. vivax strain has been already detected, suggesting that artemisinin-based combination therapies should be used to treat both parasite strains. 

Four different protozoa of the genus Plasmodium -P. falciparum, P. vivax, P. ovale and P malariae - can cause malaria. P. falciparum is the most virulent, being responsible for virtually all fatal malaria cases. Humans are infected by a feeding female Anopheles mosquito (Fig. 2). The clinical symptoms of malaria are associated with the development of the parasite within human red blood cells, while the liver stages remain asymptomatic. The following dtugs (in alphabetical order) are currently in use for the treatment of malaria [5]. 

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