RESUMEN
We describe the changing epidemiology of drug resistant malaria in Thailand over the past decade. Factors determining the characteristic patterns of the development and spread of resistance to anti-malarial drugs on the Thai-Cambodian border and the Thai-Myanmar border are explored, namely, population dynamics, drug usage and malaria control measures. The introduction of artesunate-mefloquine combination in selected areas along the two borders in 1995 is believed to be one of the multiple factors responsible for stabilizing the multidrug resistance problems in Thailand today. Other control measures and inter-governmental co-operation must continue to be strengthened in order to limit the spread of drug resistance malaria in the Southeast Asian region.
Asunto(s)
Animales , Antimaláricos/farmacología , Artemisininas , Cambodia/epidemiología , Resistencia a Medicamentos , Humanos , Malaria Falciparum/tratamiento farmacológico , Mefloquina/farmacología , Mianmar/epidemiología , Plasmodium falciparum/efectos de los fármacos , Sesquiterpenos/farmacología , Tailandia/epidemiologíaRESUMEN
We evaluated the detection of malaria parasites using acridine orange fluorescence microscopy of centrifuged blood (AOFM/CB or "QBC Malaria Test") at two government malaria clinics in rural Thailand. In a subgroup of the patients, a QBC Hematology System for the determination of complete blood counts was also utilized. A Giemsa-stained thick smear (GTS) reading of 100 (1,000x) microscopic fields was used as standard. The AOFM/CB sensitivities were 97% overall and 95% for P. falciparum (Pf). Sensitivity was lower for P. vivax (Pv) (76%). Pv sensitivity depended largely on ameboid form density. A threshold for AOFM/CB to consistently detect Pv ameboid forms was estimated to be 10/100 WBC (700/microliters blood). AOFM/CB was capable of detecting Pf gametocytes and schizonts more frequently than GTS. The total Pf rings per microliter blood estimated from GTS was highly correlated with the number of Pf rings per Paralens microscopic field (PMF) suggesting that AOFM/CB could be used quantitatively. From a technical standpoint, the rural tropical settings of Thailand in this study were not an obstacle to the use of QBC Hematology. The system was found to be useful in conjunction with AOFM/CB. However, in patients heavily infected with Pf gametocytes of Pv ameboid forms, their total WBC and lymphocyte counts needed to be appropriately corrected. Overall, AOFM/CB appears to be a promising tool for field diagnosis of malaria if it is affordable to developing countries.