128
TRANSACTIONS OFTHEROYALSOCIETY OF TROPICAL MEDICINE
~i.m HYGIENE (1992) 86, 128
References
Bailly, E., Mahouy, G., Savel, J. & Jaureguiberry, G. (1991). Plasmodium falciparum: isolation and characterization of a 55kDa proteasewith a cathepsin D-like activity from P. fa2ciparum. Experimental Parasitology,72,278-284. Fenton, B., Walker, A. & Walliker, D. (1985). Protein variation in clones of Plasmodium falciparum detected by two dimensional electrophoresis. Molecular and Biochemical Parasitology, 16,173-183.
Hempelmann, E. & Wilson, R. J. M. (1980). Endopeptidases from Plasmodiumknowlesi.Parasitology,80,323-330. Le Bras, J. & Deloron, I’. (1983). In vitro study of drug sensitivity of Plasmodium falciparum. Evaluation of new semi-micro-
Chloroquine Plasmodium Brazil
resistance in wiwax: the first case in
Pietro Luigi GaraveW and Elio Cart? ‘Department of Infectious Diseases, General Hospital, Alessandria, Italy; 2Department of Internal Medicine, Civil Hospital, Valenza PO, Italy
Recent reports have indicated that chloroquine resistancein Plasmodium vivax may be appearing for the first time (COLLIGNON, 1991; RIECKMANN et al., 1989; WHITEY ei al., 1989). Here we report apparent chloroquine resistancein P. vivax malaria contractedin Brazil. C. E., a male aged 25 years and born in Jaragua do Sul, Brazil, became infected with P. vivax in August 1990 in the Rio Madeira State of Rondonia? an area which geographically belongs to the Amazoman plain. He had been working there for many months as a gold prospector. He was treated somewhat erratically with chloroquine phosphate orally (600 mg base) and made an apparent recovery, ‘with negative stained blood films made in the following month. The patient finally left the Amazonian plain in mid December to return to his home in the Stateof SantaCaterina?far from a malaria endemic area. In January 1991the patient had another malaria attAddress for correspondence:Dottor Pietro Luigi Garavelli, Via Comunale 33, 15040Valmadonna (Al), Italy.
test. AmericanJournal of Tropical Medicine and Hygiene, 32, 447-451. Mahoney, J. R. & Eaton, J. W. (1981). Chloroquine resistant malaria: associationwith enhanced plasmodial protease activity. Biochemical and Biophysical ResearchCommunications, 100,1266-1271.
Rosario,,V. E. (1981). Cloning of naturally occurring mixed infecuons of malaria parasites.Science, 212, 1037-1038. Trager, W. & Jensen,J. B. (1976). Human malaria parasitesin continuous culture. Science,193,673-675. Received 24 July 1991; accepted for publication 8 August 1991
ack due to P. vivax (diagnosedmicroscopically) and was treated with chloroquine phosphateorally (600 mg base followed by 300 mg base6 h later, then 300 mg base/d for 2 d) followed by primaqume phosphate orally (15 mg base/d for 14 d). He again recovered and his blood slidesbecamenegative. After travelling to Italy the patient was admitted to the Department of Infectious Diseases of Alessandria GeneralHospital with a fever on 21 April 1991,and once more the diagnosis was P. vivax malaria. He was again treated conventionally with chloroquine followed by primaquine, in spite of the suspicion of chloroquine resistance,and was dischargedapparently recovered.However, on 14 August 1991 he suffered a further relapse, and was correctly treated at the Department of General Medicine of Valenza Civil Hospital with mefloquine orally (750 mg followed by So0 mg after 6 h- and 250 mu after a further 12 h). The natient is still (NovemberU1991)in good health’ and the periodical stained blood films haveremainednegative. We conclude that this was a genuine caseof chloroquine-resistant P. vivax malaria, although contirmatorv tests in vitro were not carried out. References
Collingnon, I’. (1991). Chloroquine resistance in Plasmodium vivax. Journal of Infectious Diseases,164,222-223.
Rieckmann, K. H., Davis, D. R. & Hutton, D. C. (1989).Plasmodium vivax resistance to chloroquine? Lancet, ii, 11831184.
Whitey, M., Wood,.G., Vcenendaal, J. R. & Rieckmann, K. \13;t9). Chloroqume-resistant Plasmodwm vzvax. Lancet, ii, Received 21 October 1991; revised 18 November 1991; acceptedfor publication 18 November 1991
TRANSACTIONS OFTHEROYALSOCIETY OF TROPICAL MEDICINE
~i.m HYGIENE (1992) 86, 128
References
Bailly, E., Mahouy, G., Savel, J. & Jaureguiberry, G. (1991). Plasmodium falciparum: isolation and characterization of a 55kDa proteasewith a cathepsin D-like activity from P. fa2ciparum. Experimental Parasitology,72,278-284. Fenton, B., Walker, A. & Walliker, D. (1985). Protein variation in clones of Plasmodium falciparum detected by two dimensional electrophoresis. Molecular and Biochemical Parasitology, 16,173-183.
Hempelmann, E. & Wilson, R. J. M. (1980). Endopeptidases from Plasmodiumknowlesi.Parasitology,80,323-330. Le Bras, J. & Deloron, I’. (1983). In vitro study of drug sensitivity of Plasmodium falciparum. Evaluation of new semi-micro-
Chloroquine Plasmodium Brazil
resistance in wiwax: the first case in
Pietro Luigi GaraveW and Elio Cart? ‘Department of Infectious Diseases, General Hospital, Alessandria, Italy; 2Department of Internal Medicine, Civil Hospital, Valenza PO, Italy
Recent reports have indicated that chloroquine resistancein Plasmodium vivax may be appearing for the first time (COLLIGNON, 1991; RIECKMANN et al., 1989; WHITEY ei al., 1989). Here we report apparent chloroquine resistancein P. vivax malaria contractedin Brazil. C. E., a male aged 25 years and born in Jaragua do Sul, Brazil, became infected with P. vivax in August 1990 in the Rio Madeira State of Rondonia? an area which geographically belongs to the Amazoman plain. He had been working there for many months as a gold prospector. He was treated somewhat erratically with chloroquine phosphate orally (600 mg base) and made an apparent recovery, ‘with negative stained blood films made in the following month. The patient finally left the Amazonian plain in mid December to return to his home in the Stateof SantaCaterina?far from a malaria endemic area. In January 1991the patient had another malaria attAddress for correspondence:Dottor Pietro Luigi Garavelli, Via Comunale 33, 15040Valmadonna (Al), Italy.
test. AmericanJournal of Tropical Medicine and Hygiene, 32, 447-451. Mahoney, J. R. & Eaton, J. W. (1981). Chloroquine resistant malaria: associationwith enhanced plasmodial protease activity. Biochemical and Biophysical ResearchCommunications, 100,1266-1271.
Rosario,,V. E. (1981). Cloning of naturally occurring mixed infecuons of malaria parasites.Science, 212, 1037-1038. Trager, W. & Jensen,J. B. (1976). Human malaria parasitesin continuous culture. Science,193,673-675. Received 24 July 1991; accepted for publication 8 August 1991
ack due to P. vivax (diagnosedmicroscopically) and was treated with chloroquine phosphateorally (600 mg base followed by 300 mg base6 h later, then 300 mg base/d for 2 d) followed by primaqume phosphate orally (15 mg base/d for 14 d). He again recovered and his blood slidesbecamenegative. After travelling to Italy the patient was admitted to the Department of Infectious Diseases of Alessandria GeneralHospital with a fever on 21 April 1991,and once more the diagnosis was P. vivax malaria. He was again treated conventionally with chloroquine followed by primaquine, in spite of the suspicion of chloroquine resistance,and was dischargedapparently recovered.However, on 14 August 1991 he suffered a further relapse, and was correctly treated at the Department of General Medicine of Valenza Civil Hospital with mefloquine orally (750 mg followed by So0 mg after 6 h- and 250 mu after a further 12 h). The natient is still (NovemberU1991)in good health’ and the periodical stained blood films haveremainednegative. We conclude that this was a genuine caseof chloroquine-resistant P. vivax malaria, although contirmatorv tests in vitro were not carried out. References
Collingnon, I’. (1991). Chloroquine resistance in Plasmodium vivax. Journal of Infectious Diseases,164,222-223.
Rieckmann, K. H., Davis, D. R. & Hutton, D. C. (1989).Plasmodium vivax resistance to chloroquine? Lancet, ii, 11831184.
Whitey, M., Wood,.G., Vcenendaal, J. R. & Rieckmann, K. \13;t9). Chloroqume-resistant Plasmodwm vzvax. Lancet, ii, Received 21 October 1991; revised 18 November 1991; acceptedfor publication 18 November 1991
