RESUMEN
The early molecular identification of strains of Plasmodium vivax that have a worse prognosis is important to stratify the risk of complications and choice of conduct made by medical teams. Thus, the aim of the present study was to associate the presence of polymorphisms in the pvmdr-1 and pvcrt-o resistance genes of P. vivax in patients with better or worse prognosis. This cross-sectional epidemiological study was conducted based on data obtained from the records of 120 patients diagnosed with malaria in the Brazilian Amazon. The T958M and F1076L mutations of the pvmdr-1 gene had a frequency of 3.3 and 4.2%, respectively, and primo-infected patients had a 17 times greater chance of being infected with protozoa with the T958M mutation compared to patients with previous episodes. Regarding pvcrt-o, the C393T and T786C polymorphisms had a frequency of 14.2 and 3.3%, respectively, and self-declared white patients had a 3.1 times greater chance of being infected with protozoa with the C393T polymorphism. In addition, patients with this pvcrt-o polymorphism had lower concentrations of C-reactive protein, indicating a better prognosis. These data present clues of genetic indicators useful for assessing the virulence of the parasite and the prognosis of patients with vivax malaria.
Asunto(s)
Antimaláricos , Malaria Vivax , Antimaláricos/farmacología , Proteína C-Reactiva , Cloroquina/uso terapéutico , Estudios Transversales , Resistencia a Medicamentos/genética , Humanos , Malaria Vivax/tratamiento farmacológico , Plasmodium vivax/genética , Plasmodium vivax/metabolismo , Pronóstico , Proteínas Protozoarias/genética , Proteínas Protozoarias/metabolismoRESUMEN
@#The early molecular identification of strains of Plasmodium vivax that have a worse prognosis is important to stratify the risk of complications and choice of conduct made by medical teams. Thus, the aim of the present study was to associate the presence of polymorphisms in the pvmdr-1 and pvcrt-o resistance genes of P. vivax in patients with better or worse prognosis. This cross-sectional epidemiological study was conducted based on data obtained from the records of 120 patients diagnosed with malaria in the Brazilian Amazon. The T958M and F1076L mutations of the pvmdr-1 gene had a frequency of 3.3 and 4.2%, respectively, and primo-infected patients had a 17 times greater chance of being infected with protozoa with the T958M mutation compared to patients with previous episodes. Regarding pvcrt-o, the C393T and T786C polymorphisms had a frequency of 14.2 and 3.3%, respectively, and self-declared white patients had a 3.1 times greater chance of being infected with protozoa with the C393T polymorphism. In addition, patients with this pvcrt-o polymorphism had lower concentrations of C-reactive protein, indicating a better prognosis. These data present clues of genetic indicators useful for assessing the virulence of the parasite and the prognosis of patients with vivax malaria.
RESUMEN
The determination of parasitemia in the diagnosis of malaria is a routine practice because it assists the selection of treatment. The techniques used for estimating parasitemia are based on leukocyte counts or on a fixed volume of blood examined in a microscopic field. This study evaluated the concordance between parasitemia estimated by counting parasites in 200 microscopic fields and by counting parasites per 500 leukocytes using the automated leukocyte count as a reference. This study included 403 patients with acute malaria. The parasitemia levels obtained by each method varied greatly. A large discrepancy was observed between the 2 methods with respect to parasitemia results, with 17.6% and 82.4% of the values being overestimates and underestimates, respectively, compared to quantification by the automated leukocyte counts. Thus, these findings reveal the inaccuracy of this method and should be considered by health professionals involved in clinical management of the disease.