Plasmodium falciparum: drug-resistant malaria complicating leukemias and lymphomas in children.
The present communication deals with drug-resistant Plasmodium falciparum malaria complicating hematologic malignancies (leukemias, n = 24, and lymphomas, n = 7) in children. Of 50 cases of hematologic malignancies, 31 patients were microscopically diagnosed as having P. falciparum infection (MP +). Initially, all the patients were treated with chloroquine. The results of primary treatment showed chloroquine resistance in 16 (51. 62%) cases. Of these 16 chloroquine-resistant cases, 13 were secondarily treated with a combination of pyrimethamine plus sulfamethopyrazine. The results of secondary treatment also revealed resistance to pyrimethamine plus sulfamethopyrazine in 6 of 13 (46. 10%) cases. The 6 pyrimethamine plus sulfamethopyrazine-resistant P. falciparum cases were finally cured by quinine therapy, against which no resistance was encountered. Conversely, in the control group comprising 38 cases of P. falciparum without malignancy, the incidence of chloroquine resistance was found in only 9 cases, which is rather low (23.70%). Of these 7 chloroquine-resistant cases, 5 were found to be sensitive to pyrimethamine plus sulfamethopyrazine treatment, while the 2 nonresponders were finally cured with quinine. The overall results of this study show a high prevalence of chloroquine resistance among clinical cases of falciparum malaria (25/69; 30.6%). Among the nonresponders (n = 20) 40% of cases were also resistant to the pyrimethamine plus sulfamethopyrazine combination. There was no resistance to quinine.
Nirmala
Department of Pathology, King George's Medical College, Lucknow, India.
Kumar
A
A
Kapoor
A K
AK
Lal
B
B
Dutta
G P
GP
Swaroop
A
A
D000293:Adolescent; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000494:pharmacology / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006689:Hodgkin Disease / Q000150:complications*; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications*; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011739:Pyrimethamine / Q000494:pharmacology / Q000627:therapeutic use; D011803:Quinine / Q000627:therapeutic use; D013415:Sulfalene / Q000494:pharmacology / Q000627:therapeutic use
D000962:Antimalarials; D002738:Chloroquine; D011803:Quinine; D013415:Sulfalene; D011739:Pyrimethamine