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Am. J. Trop. Med. Hyg., 74(5), 2006, pp. 758-761
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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SHORT REPORT


DYNAMICS OF PLASMODIUM FALCIPARUM MALARIA AFTER SUB-OPTIMAL THERAPY IN UGANDA

ALISSA MYRICK*, ERIKA LEEMANN, CHRIS DOKOMAJILAR, HEIDI HOPKINS, GRANT DORSEY, MOSES R. KAMYA, AND PHILIP J. ROSENTHAL
Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

 

ABSTRACT

We followed parasite genotypes of 75 patients for 42 days after treatment of uncomplicated malaria with chloroquine + sulfadoxine-pyrimethamine in Kampala, Uganda. Infections were complex (mean, 2.88 strains) and followed three patterns: 27% of patients eliminated all strains and remained parasite-free, 48% had a long aparasitemic interval followed by reappearance of original strains after 3–33 days (mean, 9.2 days), and 25% failed to clear original strains and required therapy after 3–35 days (mean, 17 days). These results highlight the complexity of malaria in Africa and have implications for efficacy trials, because missing late reappearances of strains could lead to misclassification of outcomes.

Received November 9, 2005. Accepted for publication January 27, 2006.

Acknowledgments: We thank the clinic and laboratory staff at the Makerere University/UC San Francisco Malaria Project in Kampala, as well as all of the patients who agreed to participate in the study.

Financial support: This study was supported by the National Institutes of Health (U01AI152142), the NIH Research Supplements for Underrepresented Minorities (UO1 AI152142-02S1) (AM), and the Doris Duke Charitable Foundation. P.J.R. is a Doris Duke Charitable Foundation Distinguished Clinical Scientist.

* Address correspondence to Alissa Myrick, Division of Infectious Diseases, Box 0811, U.C. San Francisco, San Francisco, CA 94143. E-mail: amyrick{at}medsfgh.ucsf.edu

Authors’ addresses: Alissa Myrick, Erika Leemann, Chris Dokomajilar, Heidi Hopkins, Grant Dorsey, and Philip J. Rosenthal, Division of Infectious Diseases, Box 0811, U.C. San Francisco, San Francisco, CA 94143. Moses R. Kamya, Makerere University Medical School, Department of Medicine, PO Box 7072, Kampala, Uganda.






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Copyright © 2006 by the American Society of Tropical Medicine and Hygiene.