One hundred cases of slide-confirmed Plasmodium falciparum malaria admitted to the San Lazaro Hospital, Manila, Philippines were screened for in vitro resistance to chloroquine, quinine, amodiaquine and mefloquine using the microtechnique. 59 of the 100 primary parasite isolates produced schizonts, whereas the remaining 41 isolates did not. 51 of the 59 isolates tested were resistant in vitro to chloroquine and eight were sensitive. In contrast, three of the primary isolates were resistant to quinine, three showed resistance to amodiaquine and four were mefloquine-resistant. 43 of the strains judged chloroquine-resistant in vitro were fully in vitro sensitive to amodiaquine, quinine and mefloquine. One chloroquine-resistant isolate was also resistant to quinine alone. Three isolates that were resistant to chloroquine were also resistant to amodiaquine. An additional three were cross-resistant to chloroquine and mefloquine. A single isolate was found to be resistant to chloroquine, quinine and mefloquine and another was cross-resistant to chloroquine, quinine and amodiaquine. All strains demonstrating in vitro resistance to amodiaquine, quinine or mefloquine also showed in vitro resistance to chloroquine. The parasites in 22 patients showed in vivo resistance to chloroquine therapy. 86% were of the R1 type, 9% were R2 and 5% R3. All 22 patients demonstrating in vivo resistance to chloroquine showed in vitro resistance.

Results are presented from the 1,000 slide-confirmed malaria cases seen during the period August 1979-September 1981 at San Lazaro Hospital, in Manila, Philippines; 56% were caused by Plasmodium falciparum, 38% by P. vivax, 6% were mixed infections, and 0.1% by P. malariae. The overall case fatality rate was 1%, all due to P. falciparum. Cerebral involvement occurred in 7% and the case fatality rate was 20% compared to a case fatality rate of 0.2% among P. falciparum cases without cerebral involvement. In vivo chloroquine-resistant P. falciparum was seen in 4% of the cases, but of those treated in 1981, 9% of the cases showed resistance. The distribution of chloroquine-resistant cases by province in the Philippines is shown, with resistance being reported for the first time from Isabela, Bulacan, Zambales, Rizal and Bataan provinces. Diagnostic, clinical, and epidemiologic aspects of the cases are discussed, as well as the trend in malaria cases over the last 20 years.

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A total of 640 blood specimens from patients in an area endemic for enteric fever were cultured in parallel in tryptic soy broth with and without sodium polyanethanol sulfonate (SPS). A total of 95 specimens were positive for Salmonella spp., 54 for Salmonella typhi, and 41 for Salmonella paratyphi A in one or both bottles of a set. Significantly higher rates of recovery were obtained from the SPS-containing medium (P < 0.01) upon subculturing blindly at 24 h and 3 days of incubation. Subcultures performed at 7, 14, and 21 days also yielded a greater number of positive cultures with SPS than without it, although the differences between the two media were not significant (P > 0.05). Neither of the media yielded 100% of the positive cultures. Moreover, even if the results of the two media were combined, 34 and l9o of the isolates would have been missed if the specimens had not been incubated to 14 and 21 days, respectively. The data indicate that SPS aids in early recovery of S. typhi and S. paratyphi A from blood cultures, and additionally, that under the conditions used in the study, incubation beyond a 1-week period is required for efficient isolation of these organisms from blood.

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