Plasmodium falciparum gametocytaemia with chloroquine chemotherapy in persistent malaria in an endemic area of India.

Background & objectives: Gametocyte sex-ratio in Plasmodium falciparum malaria is an important determinant of transmission success and basis of disease epidemiology. Information on ratio of male to female gametocytes after an exposure of antimalarial regimens under field conditions is very limited. In this retrospective study we observed high densities of gametocytes along with high sex-ratio in P. falciparum cases, which may be responsible for persistent malaria transmission in this area. Methods: Laksar PHC of Hardwar district, Uttarakhand State, India was selected because it contributed 90 per cent of the total malaria cases. A total of 568 uncomplicated P. falciparum malaria patients were assessed to investigate prevalence of gametocytes while 339 P. falciparum thick smears containing 5620 gametocytes were screened for measuring the gametocyte density for microgametocyte (male) and macrogametocyte (female). Homology of variance (‘F’ test) was checked on days 7 and 14 including the variables and risk factors namely fever, parasitaemia, gametocyte carriage in sensitive and resistant chloroquine treated P. falciparum cases. Results: Slide positivity rate (SPR) increased drastically from 0.23 to 11.4 per cent with the predominance in P. falciparum infection after 1998. All 568 cases showed gametocytes in their peripheral blood, of which 109 (19%) were infected with rings and gametocytes and 459 (81%) had gametocytes stages in their peripheral blood while 422 (74.3%) cases were infected with ring stages only. Of the 339 P. falciparum positive blood smears, 5620 gametocytes were screened for their sex-ratio. The mean sex-ratio was 0.31 (3.22 female per male). Prevalence of gametocytaemia was significantly higher (P<0.05) in chloroquine (CQ)- resistant than in CQ-sensitive patients with days 7 and 14 follow up. The homology of variance with risk factors for gametocytes on days 7 and 14 were highly significant (P<0.001) in the study period but during the post-exposure period of days 3 and 5, these were insignificantly correlated. Interpretation & conclusion: A high density of P. falciparum gametocytes was observed at the time of preparation of blood slide on day 0. Improper chloroquine treatment along with poor patient compliance for radical treatment and the presence of chloroquine resistant P. falciparum malaria may have enhanced the prevalence and density of P. falciparum gametocytes which was instrumental in signaling the persistent malaria in this area.

Gametocitemia de Plasmodium falciparum según la respuesta terapéutica a sulfadoxina-pirimetamina y cloroquina en dos municipios de Antioquia, Colombia / Gametocyte levels in response to differing malaria treatments in two municipalities of Colombia

Se ha informado que el número de gametocitos circulantes de Plasmodium falciparum está influenciado por aspectos como el nivel de endemicidad de la zona, la clase de esquizonticidas sanguíneos usados y la respuesta terapéutica a ellos. En Colombia son muy pocos los trabajos que han evaluado estas relaciones. Mediante un diseño experimental, se evaluó la gametocitemia (variable efecto) en función del nivel endémico de dos municipios de Antioquia, del tratamiento (sulfadoxina-pirimetamina y sulfadoxina-pirimetamina más cloroquina) y de la respuesta terapéutica (adecuada y fallida). Se estudiaron 148 pacientes con malaria por P. falciparum no complicada. La gametocitemia varía en función del tiempo de padecimiento de la malaria actual (mayor en Turbo que en Zaragoza) y esta variable debe controlarse para eliminar la aparente diferencia en las gametocitemias por municipio. No se hallaron diferencias estadísticamente significativas en la gametocitemia (porcentaje de pacientes con gametocitos circulantes y cantidad de ellos por microlitro) según el tratamiento y la respuesta terapéutica, aunque los niveles de gametocitos son mayores en los pacientes tratados sólo con sulfadoxinapirimetamina, respecto a quienes recibieron sulfadoxina-pirimetamina más cloroquina. Tampoco hubo diferencias en la gametocitemia según el sexo ni la edad de los pacientes, ni se halló correlación de ella con la parasitemia asexual. La diferencia en el nivel de gametocitemia encontrada entre los municiios de Turbo y Zaragoza parece estar influida por el tiempo transcurrido entre el inicio de los síntomas y la instauración del tratamiento.

Plasmodium falciparum gametocyte levels are influenced by level of regional endemicity, the antimalarial treatment, and the therapeutic response of patients. Few previous studies have related these factors in Colombia. Here, gametocytaemia was evaluated with respect to two treatment schemes (sulfadoxine/pyrimethamine and sulfadoxine/pyrimethamine plus chloroquine), the patient response (adequate or failure), and the locality (two areas of varying case frequency). One hundred forty-eight residents of Turbo and Zaragoza (Antioquia), all with uncomplicated malaria, were evaluated. The gametocytaemia and the rates of clinical malaria at the beginning of treatment were greater in Turbo than in Zaragoza. No statiscally significant differences in the gametocytaemia by treatment schemes or therapeutic responses were noted, although the patients who received SP had more gametocytes than those treated with SP+CQ. Gametocytaemia was not correlated with asexual parasitemia or sex and age of patient. The difference in the level of gametocytaemia between Turbo and Zaragoza appears to be influenced by the time elapsed between the appearance of symptoms and the beginning of treatment.