Primaquine double dose for 7 days is inferior to single-dose treatment for 14 days in preventing Plasmodium vivax recurrent episodes in Suriname.

BACKGROUND: Recurrent episodes of Plasmodium vivax are caused by dormant liver stages of the parasite, which are not eradicated by choloroquine. Therefore, effective treatment also includes the use of primaquine (PQ). However, this secondary preventive therapy is often not effective, mostly due to poor adherence to the relatively long treatment course, justifying a comparative study of the efficacy of different durations of PQ treatment. MATERIALS AND METHODS: We included patients presenting with an acute and documented P. vivax infection from January 2006 to February 2008. All patients received chloroquine 25 mg/kg over a 3-day period. Subsequently, patients in group 7D received PQ 30 mg/day for 7 days, and patients in group 14D received standard PQ 15 mg/day for 14 days. All doses were given under supervision and patients were followed up for at least 6 months. The Kaplan-Meier method was used to estimate cumulative probability of recurrence up to 12 months after treatment initiation stratified by treatment group. Cox regression was used to assess possible determinants for recurrent parasitemia. RESULTS: Forty-seven of the 79 included patients (59.5%) were allocated to group 7D and 32 patients (40.5%) were allocated to group 14D. Recurrent parasitemia was detected in 31.9% of the cases in group 7D compared to 12.5% of the cases in group 14D (hazard ratio [HR] =3.36, 95% CI 1.11-10.16). Cumulative probability for recurrent parasitemia at 3, 6, and 12 months was 0.201 (95% CI 0.106-0.362), 0.312 (95% CI 0.190-0.485), and 0.424 (95% CI 0.274-0.615) for group 7D and 0.100 (95% CI 0.033-0.279), 0.100 (95% CI 0.033-0.279), and 0.138 (95% CI 0.054-0.327) for group 14D, respectively. When adjusted for possible confounders, differences in recurrent parasitemia remained significant between the two regimens in Cox regression analysis. CONCLUSION: More than 30% of the patients receiving shorter treatment course had recurrent parasitemia, suggesting that the standard dose of 15 mg/day PQ for 14 days is more efficacious than 30 mg for 7 days in preventing P. vivax recurrent episodes. Furthermore, we suggest that P. vivax treatment in Suriname should be changed to PQ 30 mg/day for 14 days, as per Center for Disease Control and Prevention recommendation, in light of a recurrence rate of over 10%, even in group 14D.

Prevalence, determinants and genetic diversity of hepatitis C virus in the multi-ethnic population living in Suriname.

Little is known about the epidemiology of HCV in Suriname, a former Dutch colony in South America. To study the prevalence, determinants and genetic diversity of HCV, a one-month survey was conducted at the only Emergency Department in the capital Paramaribo. Participants (≥18 years) completed an interviewer-led standardized HCV risk-factor questionnaire, were tested for HCV-antibodies, and if positive also for HCV RNA. The overall HCV prevalence was 1.0% (22/2128 participants; 95%CI 0.7-1.5). Male sex (OR=4.11; 95%CI 1.30-13.01), older age (OR=1.06 per year increase; 95%CI 1.04-1.09), Javanese ethnicity (OR=7.84; 95%CI 3.25-18.89) and cosmetic tattooing (OR=31.7; 95%CI 3.25-323.87) were independently associated with HCV-infection. Phylogenetic analysis revealed six distinct HCV subtypes, all HCV-genotype 2 (HCV-2): subtype 2f (also circulating in Indonesia) plus five yet unassigned HCV-2 subtypes exclusively linked to Suriname.

[Chikungunya in children]. / Chikungunya bij kinderen.

Chikungunya is a rapidly spreading infectious disease throughout the Caribbean, reaching epidemic proportions in Suriname, with more than 1200 registered cases in 2014. Similar to dengue, classic symptoms are high fever, rash and arthralgia. However, the presentation differs in adults and children. At the Academic Hospital Paramaribo in Suriname, three children had different presentations of chikungunya. An 11-year-old girl was referred to the paediatric centre with acute-onset fever of 40.5ºC, painful knees and a rash on face and arms. Koplik spots were visible on the inside of her mouth. A 13-year-old boy attended the ER with acute-onset fever and a state of reduced consciousness. Physical examination revealed hypotension, tachycardia and fever. No rash was observed. A 2.5-month-old baby with fever, vomiting, diarrhoea and a rash was brought to the ER. She was agitated and had signs of meningism. The symptoms resolved quickly in all patients after rehydration and pain medication.