Universidad Peruana Cayetano Heredia

Plasmodium vivax morbidity after radical cure: A cohort study in Central Vietnam

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dc.contributor.author Pham, T.V.
dc.contributor.author Van Nguyen, H.
dc.contributor.author Aguirre, A.R.
dc.contributor.author Van Nguyen, V.
dc.contributor.author Cleves, M.A.
dc.contributor.author Nguyen, X.X.
dc.contributor.author Nguyen, T.T.
dc.contributor.author Tran, D.T.
dc.contributor.author Le, H.X.
dc.contributor.author Hens, N.
dc.contributor.author Rosanas-Urgell, A.
dc.contributor.author D’alessandro, U.
dc.contributor.author Speybroeck, N.
dc.contributor.author Erhart, A.
dc.date.accessioned 2019-12-06T21:02:52Z
dc.date.available 2019-12-06T21:02:52Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/7462
dc.description.abstract Background: In Vietnam, the importance of vivax malaria relative to falciparum during the past decade has steadily increased to 50%. This, together with the spread of multidrug-resistant Plasmodium falciparum, is a major challenge for malaria elimination. A 2-year prospective cohort study to assess P. vivax morbidity after radical cure treatment and related risk factors was conducted in Central Vietnam. Methods and findings: The study was implemented between April 2009 and December 2011 in four neighboring villages in a remote forested area of Quang Nam province. P. vivax-infected patients were treated radically with chloroquine (CQ; 25 mg/kg over 3 days) and primaquine (PQ; 0.5 mg/ kg/day for 10 days) and visited monthly (malaria symptoms and blood sampling) for up to 2 years. Time to first vivax recurrence was estimated by Kaplan–Meier survival analysis, and risk factors for first and recurrent infections were identified by Cox regression models. Among the 260 P. vivax patients (61% males [159/260]; age range 3–60) recruited, 240 completed the 10-day treatment, 223 entered the second month of follow-up, and 219 were followed for at least 12 months. Most individuals (76.78%, 171/223) had recurrent vivax infections identified by molecular methods (polymerase chain reaction [PCR]); in about half of them (55.61%, 124/223), infection was detected by microscopy, and 84 individuals (37.67%) had symptomatic recurrences. Median time to first recurrence by PCR was 118 days (IQR 59–208). The estimated probability of remaining free of recurrence by month 24 was 20.40% (95% CI [14.42; 27.13]) by PCR, 42.52% (95% CI [35.41; 49.44]) by microscopy, and 60.69% (95% CI [53.51; 67.11]) for symptomatic recurrences. The main risk factor for recurrence (first or recurrent) was prior P. falciparum infection. The main limitations of this study are the age of the results and the absence of a comparator arm, which does not allow estimating the proportion of vivax relapses among recurrent infections. Conclusion: A substantial number of P. vivax recurrences, mainly submicroscopic (SM) and asymptomatic, were observed after high-dose PQ treatment (5.0 mg/kg). Prior P. falciparum infection was an important risk factor for all types of vivax recurrences. Malaria elimination efforts need to address this largely undetected P. vivax transmission by simultaneously tackling the reservoir of P. falciparum and P. vivax infections. en_US
dc.language.iso eng
dc.publisher Public Library of Science
dc.relation.ispartofseries PLoS Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject adult en_US
dc.subject artemisinin en_US
dc.subject Article en_US
dc.subject child en_US
dc.subject chloroquine en_US
dc.subject DNA extraction en_US
dc.subject drug megadose en_US
dc.subject female en_US
dc.subject fever en_US
dc.subject follow up en_US
dc.subject genetic polymorphism en_US
dc.subject glucose 6 phosphate dehydrogenase en_US
dc.subject headache en_US
dc.subject human en_US
dc.subject information processing en_US
dc.subject leukocyte count en_US
dc.subject major clinical study en_US
dc.subject malaria en_US
dc.subject malaria falciparum en_US
dc.subject male en_US
dc.subject microscopy en_US
dc.subject middle aged en_US
dc.subject mixed infection en_US
dc.subject morbidity en_US
dc.subject parasite clearance en_US
dc.subject parasite identification en_US
dc.subject Plasmodium falciparum en_US
dc.subject Plasmodium vivax en_US
dc.subject Plasmodium vivax malaria en_US
dc.subject polymerase chain reaction en_US
dc.subject prevalence en_US
dc.subject primaquine en_US
dc.subject prospective study en_US
dc.subject quality control en_US
dc.subject recurrent disease en_US
dc.subject risk factor en_US
dc.subject South China Sea en_US
dc.subject sputum smear en_US
dc.subject treatment response en_US
dc.title Plasmodium vivax morbidity after radical cure: A cohort study in Central Vietnam en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1371/journal.pmed.1002784
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.03
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#1.06.01
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#2.08.00
dc.relation.issn 1549-1676


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