Microbiology and Parasitology

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Browsing Microbiology and Parasitology by Subject "Artemether-lumefantrine"

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    Occurrence of day 3 submicroscopic plasmodium falciparum parasitaemia before and after implementation of artemether-lumefantrine treatment policy in Tanzania.
    (BMJ Global Health, 2017) Mwaiswelo, Richard O.
    Background Emergence ofPlasmodium falciparumresistanceagainst artemisinin in Southeast Asia raises a serious concernabout the long-term efficacy of artemisinin-based combinationtherapy (ACT) globally. In Africa, ACT has remained highlyefficacious with a microscopy determined asexual parasites clear-ance occurring within 48 hours post-treatment in most patients.However, submicroscopic parasitaemia has been reported onDay 3 after ACT treatment. We assessed the prevalence ofpatients with submicroscopic parasitaemia on Day 3 and its asso-ciated factors following treatment with artemether-lumefantrine(AL) from 2006 to 2014 in Bagamoyo district, Tanzania.MethodsCytochrome b-nested polymerase chain reaction(PCR) was used for screening of submicroscopic parasitaemiafrom blood samples collected onfilter paper on Day 3 post-ALtreatment for acute uncomplicatedP. falciparummalaria.Primary outcome was proportion of patients with submicro-scopic parasitaemia on Day 3 from 2006 to 2014. Secondaryoutcomes included proportional difference in submicroscopicparasitaemia across years, association of pre-treatment character-istics with submicroscopic parasitaemia, and association of sub-microscopic parasitaemia with recurrent infection ResultsOnly 2/584 (0.34%) of the screened patients hadmicroscopy determined parasitaemia on Day 3, whereas, 256/584 (43.8%) had submicroscopic parasitaemia. Submicroscopicparasitaemia prevalence increased from 28% (14/50) in 2006 to74.2% (132/178) in 2007–8, and thereafter declined to 36%(50/139) in 2012–13 and 27.6% (60/217) in 2014, with thelikelihood of being positive for submicroscopic parasitaemiadecreasing by 14.7% (95% CI: 9.5–19.7%, p<0.001) for anincrease in year by one. Pre-treatment parasitaemia >100,000/mL, haemoglobin <10 g/dL, fever, being aged <5 years andyear of study 2007–8 and 2012–13 were associated with thepresence of submicroscopic parasitaemia. There was no associ-ation between submicroscopic parasitaemia and recurrentinfection.ConclusionsDay 3 submicroscopic parasitaemia was commonin patients treated with AL before and after implementation ofthe policy, and changed considerably across years from 2006 to2014, however, its presence was associated with pre-treatmentcharacteristics.