Levels of primaquine and carboxyprimaquine in patients with malaria vivax from the Brazilian Amazon basin

ABSTRACT In the last two years, a substantial increase in the number of malaria vivax cases has occurred in the Brazilian Amazon basin. The adequate exposure of hypnozoites to primaquine is a matter of interest as these dormant forms are responsible for the maintenance or even the increase of malari...

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Bibliographic Details
Published in:Revista do Instituto de Medicina Tropical de São Paulo
Main Authors: Amanda Gabryelle Nunes Cardoso Mello, Michelle Valéria Dias Ferreira Vieira, Luann Wendel Pereira de Sena, Thiago Portal da Paixão, Ana Carla Godinho Pinto, Daniella Paternostro de Araújo Grisólia, Margareth Tavares Silva, José Luiz Fernandes Vieira
Format: Article in Journal/Newspaper
Language:English
Published: Universidade de São Paulo (USP) 2018
Subjects:
Malaria
Hypnozoite
Primaquine
Arctic medicine. Tropical medicine
RC955-962
Infectious and parasitic diseases
RC109-216
Arctic
Online Access:https://doi.org/10.1590/s1678-9946201860066
https://doaj.org/article/318a18b48efb4906b128d9385aa4a8a6
Description
Summary:ABSTRACT In the last two years, a substantial increase in the number of malaria vivax cases has occurred in the Brazilian Amazon basin. The adequate exposure of hypnozoites to primaquine is a matter of interest as these dormant forms are responsible for the maintenance or even the increase of malaria burden in endemic areas. The aim of this study was to estimate the levels of primaquine and carboxyprimaquine in whole blood samples of patients with P. vivax treated with chloroquine and an abbreviated regimen of primaquine (0.5 mg/kg/d for 7 days), with adequate clinical and parasitological outcomes after 180 days of follow-up. A total of 40 male patients met the criteria for inclusion in the study. Primaquine and carboxyprimaquine were measured by high-performance liquid chromatography. The levels of primaquine in whole blood samples ranged from 40-238 ng/mL, 42-196 ng/mL and 42-150 ng/mL on days 1, 3 and 7. The levels of carboxyprimaquine in whole blood samples ranged from 87-234 ng/mL, 96-252 ng/mL and 74-448 ng/mL on days 1, 3 and 7. These data provide a reliable estimation of exposure of the infecting parasite to primaquine. Based on the regional pattern of relapse, the estimated blood levels of primaquine can be considered effective against hypnozoites of the local circulating strains of P. vivax.

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