Efficacy of chloroquine in the treatment ofPlasmodium vivaxmalaria in Turkey

Abstract

Precise knowledge of the natural history of cystic echinococcosis (CE) in humans remains somewhat arcane. The aim of the present study was to determine whether aspects of the natural history of established human infection with Echinococcus granulosus could be investigated by using a cross-sectional approach, in a community where CE was endemic. A mass ultrasound-screening survey, coupled with a questionnaire to record all previous surgical histories related to CE, was carried out amongst the primarily transhumant Berber people of the Mid Atlas mountains in Morocco. During two periods of intensive screening, of 10 days in May 2000 and 11 days in May 2001, 11,612 people, representing > 98% of the local population, were checked. One hundred and twenty six (1.1%) of the subjects--75 (59.5%) of the 6864 females investigated and 51 (40.5%) of the 4748 males--were found ultrasound-positive for CE. Overall, 14.1% of the CE cases detected were children aged 1-15 years (who made up 44% of the study population). Most (77.4%) of the ultrasound-positive subjects investigated were also found seropositive for CE. The frequency of a past history of surgery for CE increased with subject age (P = 0.024), 125 (1.1%) of the subjects being recorded as having had such surgery. The frequency of surgery for pulmonary CE was relatively constant in all age-groups, indicating that infection can occur at any time. The frequency of abdominal CE increased with age (R2 = 0.8102). Assuming that the incidence of infection remains fairly constant over time and that the longer a person spends in this endemic area the more likely it is that he or she will develop CE, then a progression from active through transitional to inactive CE should occur. The cysts observed by ultrasound in the present study were categorized, as type 1, 2, 3, 4 or 5, according to the new, standardized, ultrasound classification of CE developed by the World Health Organization (WHO). There was a clear exponential decline in the frequency of the various cyst types, from type 1 (the most frequent) to type 5 (the rarest). This decline validates the assumptions made, about the natural history of established CE, by those who developed the WHO's classification. The classification should therefore be invaluable to surgeons and clinicians, when they have to consider treatment options for patients with the various types of CE, and to policy makers trying to establish the economic costs of treating CE in endemic settings.

Resistance to Therapies for Infection by Plasmodium vivax

“…Studies in Pakistan, Afghanistan, and Azerbaijan have shown little or no evidence of resistance (121,134,227). Reports from Turkey showed 85% to 90% susceptibility (129), but a more recent survey from the southeastern sector showed only 78% susceptibility (130). Systematic surveys in South America showed evidence ranging from complete susceptibility to a very low risk of resistance (Ͻ5%) (38,188), but one survey of just 27 patients found 89% susceptibility (207).…”

Monitoring of failure of chloroquine treatment for Plasmodium vivax using polymerase chain reaction in Sanliurfa province, Turkey

“…Recent studies have indicated that there is a high risk of therapeutic failure in patients given CQ to cure P. vivax malaria or probably the presence of CQ resistance. While CQ failure levels were about 12.5% in 2004, they rise to about 20.9% in 2006 in this region (Kurcer et al 2004(Kurcer et al , 2006. We recommended that further studies by using SnM-PCR in the way of including more malaria patients are required in order to clarify the CQ failure due to the different findings obtained from our region.…”

“…Two of our studies have demonstrated that there is CQ treatment failure of P. vivax malaria in southeastern Turkey (Kurcer et al 2004(Kurcer et al , 2006. In addition, previous studies have shown that if PCR yields positive results for a period of 5 to 8 days after treatment, therapeutic failure possibly due to parasite resistance may be predicted (Rubio et al 1999a).…”

“…Of these cases, about 109,000 occurred in the southeast of Turkey, particularly in the Sanliurfa province (The Ministry of Health of Turkey 2002; Akkafa et al 2002). Because of "The Southeastern Anatolia Irrigation Project", most of the malaria cases in the southeastern region (14.3%) were reported in the Sanliurfa province and within the term of the last 6 years (Akkafa et al 2002;Kurcer et al 2004).…”

Mutational Analysis of Plasmodium vivax dhfr Gene Among Cases in South East of Iran

“…It has been shown that there is a considerable increase of CQ and SP resistance in P. vivax (11,13,14). Therefore, according to the increase of drug resistance in P. vivax, elimination of this species is further complicated (15).…”