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Multiple relapses of Plasmodium vivax malaria acquired from West Africa and association with poor metabolizer CYP2D6 variant: a case report

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机构: [1]Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan, 650500, People's Republic of China. [2]Shanglin County People's Hospital, Shanglin, Guangxi, 530500, People's Republic of China. [3]Guangxi Zhuang Autonomous Region People's Hospital, Nanning, Guangxi, 530021, People's Republic of China. [4]Eijkman-Oxford Clinical Research Unit, Jalan Diponegoro No. 69, Jakarta, 10430, Indonesia. [5]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK. [6]Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, 530021, People's Republic of China. [7]Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Blvd, Suite 304, Tampa, FL, 33612, USA. lcui@health.usf.edu.
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关键词: Plasmodium vivax West Africa Relapse pattern Primaquine failure CYP2D6

摘要:
Plasmodium vivax transmission in West Africa, dominant for the Duffy-negative blood group, has been increasingly recognized from both local residents as well as international travelers who contracted P. vivax malaria there. However, the relapsing pattern and sensitivity to antimalarial treatment of P. vivax strains originated from this region are largely unknown. There is evidence that the efficacy of primaquine for radical cure of relapsing malaria depends on host factors such as the hepatic enzyme cytochrome P450 (CYP) 2D6.A 49-year-old Chinese man was admitted to the Shanglin County Hospital in Guangxi Province, China, on December 19, 2016, 39 days after he returned from Ghana, where he stayed for one and a half years. He was diagnosed by microscopy as having uncomplicated P. vivax malaria. Treatment included 3 days of intravenous artesunate (420 mg total), and 3 days of chloroquine (1550 mg total), and 8 days of primaquine (180 mg total). Although parasites and symptoms were cleared rapidly and he was malaria-negative for almost two months, he suffered four relapses with relapse intervals ranging from 58 to 232 days. The last relapse occurred at 491 days from his first vivax attack. For the first three relapses, he was treated similarly with chloroquine and primaquine, sometimes supplemented with additional artemisinin combination therapies (ACTs). For the last relapse, he was treated with intravenous artesunate, 3 days of an ACT, and 7 days of azithromycin, and had remained healthy for 330 days. Molecular studies confirmed P. vivax infections for all the episodes. Although this patient was diagnosed to have normal glucose-6-phosphate dehydrogenase (G6PD) activity, his CYP2D6 genotype corresponded to a *2A/*36 allele variant suggesting of an impaired primaquine metabolizer phenotype.This clinical case suggests that P. vivax malaria originating from West Africa may produce multiple relapses extending beyond one year. The failures of primaquine as an anti-relapse therapy may be attributed to the patient's impaired metabolizer phenotype of the CYP2D6. This highlights the importance of knowing the host G6PD and CYP2D6 activities for effective radical cure of relapsing malaria by primaquine.

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出版当年[2019]版:
大类 | 3 区 医学
小类 | 3 区 传染病学
最新[2023]版:
大类 | 3 区 医学
小类 | 3 区 传染病学
第一作者:
第一作者机构: [1]Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan, 650500, People's Republic of China.
通讯作者:
通讯机构: [1]Department of Pathogen Biology and Immunology, Kunming Medical University, Kunming, Yunnan, 650500, People's Republic of China. [6]Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, Guangxi, 530021, People's Republic of China.
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