BACKGROUND: The aim of this study was to evaluate the rates of parasitaemia clearance and the prevalence of treatment failure in patients with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (AL), mefloquine (MQ), and atovaquone-proguanil (AP). METHOD: The retrospective descriptive study included adult patients with uncomplicated P. falciparum malaria treated at the University Hospital Bulovka in Prague from 2006 to 2019. Parasitaemia clearance was estimated using a linear regression model. RESULTS: The study included 72 patients with a median age of 33 years (IQR 27-45) and a male to female ratio of 3.2:1. Thirty-six patients (50.0%) were treated with AL, 27 (37.5%) with MQ and 9 (12.5%) with AP. The proportion of VFR and migrants was 22.2% with no significant differences among the three groups. The median time to the parasitaemia clearance was two days (IQR 2-3) in patients treated with AL versus four days in the MQ (IQR 3-4) and AP (IQR 3-4) groups, p < 0.001. The clearance rate constant was 3.3/hour (IQR 2.5-4.0) for AL, 1.6/hour (IQR 1.3-1.9) for MQ, and 1.9/hour (IQR 1.3-2.4) for AP, p < 0.001. Malaria recrudescence occurred in 5/36 (13.9%) patients treated with AL and in no patients treated with MQ or AP. CONCLUSIONS: The findings demonstrate the superior efficacy of AL compared to other oral antimalarials in early malaria treatment. However, we observed a higher rate of late treatment failure in patients treated with AL than previously reported. This issue warrants further investigation of possible dose adjustments, extended regimens, or alternative artemisinin-based combinations.

• MeSH
• Antimalarials * adverse effects   MeSH
• Artemether therapeutic use   MeSH
• Adult MeSH
• Ethanolamines therapeutic use   MeSH
• Drug Combinations MeSH
• Artemether, Lumefantrine Drug Combination therapeutic use   MeSH
• Middle Aged MeSH
• Humans MeSH
• Malaria * drug therapy   MeSH
• Mefloquine therapeutic use   adverse effects   MeSH
• Treatment Failure MeSH
• Plasmodium falciparum MeSH
• Retrospective Studies MeSH
• Malaria, Falciparum * drug therapy   epidemiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The K13 propeller domain mutation and pfmdr1 amplification have been proposed as useful molecular markers for detection and monitoring of artemisinin resistant Plasmodium falciparum Welch, 1897. Genomic DNA isolates of P. falciparum was extracted from 235 dried blood spot or whole blood samples collected from patients with uncomplicated falciparum malaria residing in areas along the Thai-Myanmar border during 2006-2010. Nested polymerase chain reaction (PCR) and sequencing were performed to detect mutations in K13 propeller domain of P. falciparum at codon 427-709. Pfmdr1 gene copy number was determined by SYBR Green I real-time PCR. High prevalence of pfmdr1 multiple copies was observed (42.5% of isolates). The presence of K13 mutations was low (40/235, 17.2%). Seventeen mutations had previously been reported and six mutations were newly detected. The C580Y was found in two isolates (0.9%). The F446I, N458Y and P574L mutations were commonly detected. Seven isolates had both K13 mutation and pfmdr1 multiple copies. It needs to be confirmed whether parasites harbouring both K13 mutation and pfmdr1 multiple copies and/or the observed new mutations of K13 propeller domain are associated with clinical artemisinin resistance.

• MeSH
• Antimalarials pharmacology   MeSH
• Artesunate pharmacology   MeSH
• Drug Combinations MeSH
• Drug Resistance genetics   MeSH
• Humans MeSH
• Mefloquine pharmacology   MeSH
• Kelch Repeat MeSH
• Plasmodium falciparum drug effects   genetics   MeSH
• Polymerase Chain Reaction MeSH
• Multidrug Resistance-Associated Proteins analysis   MeSH
• Protozoan Proteins analysis   MeSH
• Sequence Analysis, DNA MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Myanmar MeSH
• Thailand MeSH

• MeSH
• Antimalarials * contraindications   therapeutic use   MeSH
• Atovaquone adverse effects   therapeutic use   MeSH
• Chemoprevention MeSH
• Doxycycline contraindications   poisoning   therapeutic use   MeSH
• Hydroxychloroquine adverse effects   therapeutic use   MeSH
• Breast Feeding MeSH
• Humans MeSH
• Malaria * parasitology   prevention & control   transmission   MeSH
• Mefloquine adverse effects   therapeutic use   MeSH
• Proguanil adverse effects   therapeutic use   MeSH
• Pregnancy drug effects   MeSH
• Check Tag
• Humans MeSH
• Pregnancy drug effects   MeSH

V posledních letech dochází celosvětově k poklesu morbidity i mortality na malárii, přesto však toto onemocnění zůstává i nadále významnou hrozbou pro populaci v endemických oblastech i pro cestovatele. Vzhledem ke globální rezistenci malarických plasmodií na chlorochin, s výjimkou Střední Ameriky a ostrova Hispaniola, a následkem přerušení dodávek meflochinu do České republiky v loňském roce jsou u nás v současné době klíčovými prostředky anti-malarické chemoprofylaxe kombinovaný přípravek atovaquon/proguanil a doxycyclin. První z nich je vhodný ke krátkodobé profylaxi tropické malárie v oblastech s výskytem Plasmodium falciparum, druhý je možné použít pro dlouhodobou ochranu v trvání měsíců až několika let. V obou případech je však nutné znát jejich interakce a způsoby užívání s cílem zabránit vzniku průlomových infekcí; např. užívání kombinovaného přípravku atovaquon/proguanil nalačno nebo zapíjení doxycyclinu mlékem či ovocným sirupem s obsahem kalcia může vést k jejich nedostatečnému účinku a k ohrožení zdraví a života cestovatele.

Despite the reduction of malaria morbidity and mortality worldwide in recent years, it is still considered to be an important threat to the population living in endemic areas as well as to foreign travelers. Due to global resistance to chloroquine, with the exception of Central America and the island of Hispaniola, and owing to delivery suspension of mefloquine to the Czech Republic since the last year, the key agents for malaria chemoprophylaxis are currently atovaquone/proguanil and doxycycline in our country. The former is suitable for a short term prophylaxis in areas of tropical malaria caused by Pl. falciparum, the latter can be used for a long term prophylaxis even for several months and up to several years. However, it is important to be familiar with their interactions and conditions of usage in order to prevent break through infections, e.g. taking atovaquone/proguanil on an empty stomach or doxycycline with milk or fruit syrup containing calcium may result in reduction of their effect and in jeopardizing the health and life of the traveler.

• MeSH
• Antimalarials therapeutic use   MeSH
• Atovaquone administration & dosage   therapeutic use   MeSH
• Chemoprevention * MeSH
• Child MeSH
• Doxycycline administration & dosage   therapeutic use   MeSH
• Drug Combinations MeSH
• Hydroxychloroquine administration & dosage   therapeutic use   MeSH
• Humans MeSH
• Malaria * prevention & control   MeSH
• Mefloquine MeSH
• Drug-Related Side Effects and Adverse Reactions MeSH
• Proguanil administration & dosage   therapeutic use   MeSH
• Pregnant People MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

Onemocnění malárii je čtvrtou nejčastější příčinou úmrtí dětí na africkém kontinentě a společně s novorozeneckou úmrtností a gastrointestinálními a respiračními infekcemi nadále tvoří vážný zdravotnický problém v tomto regionu. Výskyt tropické malárie u kojencú zaznamenávaný v evropských zemích je oproti tomu relativně vzácný a i z tohoto důvodu je zřetelně obtížnější časné odhalení choroby v rámci diferenciální diagnostiky febrilního stavu u této věkové skupiny. Autoři předkládají kazuistiku pětiměsíčního kojence z Kamerunu, který při pobytu v České republice onemocněl tropickou malárii. Nespecifické příznaky, vysoká parazitémie a známky počínající poruchy koagulace byly hlavními rysy závažně probíhajícího onemocnění. V závěru je upozorněno na omezené možnosti profylaxe a léčby tropické malárie u kojenců.

Malaria is the fourth most frequent cause of death in African children. Connected with perinatal diseases as well as gastrointestinal and respiratory infections malaria has been still a serious health problem of that region. Occurrence of tropical malaria in infants reported in European countries is relatively rare. Not only from that reason, the assesment of diagnosis in children under one year of age seems to be obviously more difficult. The authors report the malaria in five-month-old infant from Cameroon who became ill during his stay in the Czech Republic. Non-specific symptoms, high level of parasitemia and impairment of blood coagulation were the main features of the emergent infection. On conclusion, the lack of suitable forms of children's antimalarial drugs both for profylaxis and treatment is mentioned.

• MeSH
• Infant MeSH
• Humans MeSH
• Malaria diagnosis   etiology   therapy   MeSH
• Mefloquine administration & dosage   therapeutic use   MeSH
• Plasmodium falciparum isolation & purification   parasitology   MeSH
• Sepsis diagnosis   etiology   therapy   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• Keywords
• Delogil, Resorchin, Aralen, Nivaquine, Lariam, Mephaquin, Atovaquin, Proquanil, Doxyhexal, Tachenoquine, Riamet, Lap Dap, Artemisin,
• MeSH
• Antimalarials administration & dosage   pharmacology   adverse effects   MeSH
• Artemether MeSH
• Chemoprevention methods   MeSH
• Chloroquine administration & dosage   adverse effects   MeSH
• Insecticides MeSH
• Malaria epidemiology   etiology   prevention & control   MeSH
• Mefloquine administration & dosage   contraindications   adverse effects   MeSH
• Tetracycline administration & dosage   MeSH
• Publication type
• Review MeSH

• Keywords
• Delagil, Resorchin, Paludrine, Malorone, LapDap, Riamet,
• MeSH
• Antimalarials administration & dosage   MeSH
• Travel MeSH
• Chemoprevention MeSH
• Chloroquine analogs & derivatives   administration & dosage   MeSH
• Doxycycline analogs & derivatives   MeSH
• Drug Combinations MeSH
• Communicable Disease Control MeSH
• Humans MeSH
• Malaria prevention & control   transmission   MeSH
• Mefloquine administration & dosage   MeSH
• Tropical Climate MeSH
• Check Tag
• Humans MeSH

Diferenciální diagnostika febrilního stavu v kojeneckém věku je vždy obtížná a ke stanovení správné diagnózy je velmi důležité zhodnotit veškeré dostupné údaje včetně epidemiologické anamnézy dítěte. Autoři předkládají případ pětiměsíčního kojence postiženého tropickou malárií a upozorňují na úskalí léčebných možností tohoto onemocnění u malých dětí.

• Keywords
• LARIAM, MALARONE,
• MeSH
• Antimalarials therapeutic use   MeSH
• Child MeSH
• Hematologic Tests methods   MeSH
• Infant MeSH
• Humans MeSH
• Malaria diagnosis   parasitology   therapy   MeSH
• Mefloquine administration & dosage   MeSH
• Plasmodium falciparum isolation & purification   MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Publication type
• Case Reports MeSH

• Keywords
• LARIAM,
• MeSH
• Travel MeSH
• Chemoprevention MeSH
• Humans MeSH
• Malaria drug therapy   prevention & control   MeSH
• Mefloquine adverse effects   therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Case Reports MeSH
• Geographicals
• Asia, Southeastern MeSH
• South America MeSH
• Africa, Central MeSH

• Keywords
• LARIAM,
• MeSH
• Antimalarials MeSH
• Adult MeSH
• Drug Resistance MeSH
• Humans MeSH
• Malaria diagnosis   drug therapy   MeSH
• Mefloquine adverse effects   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH