engleski

Quo vadis malaria?

Malaria is the most important parasitic disease causing many deaths and significant morbidity in tropical and subtropical countries. During the past century malaria was eliminated in many countries in the world, but malaria elimination and ultimately eradication from the remaining endemic countries represent a complex, costly and long-lasting challenge. There is the evidence that the epidemiology of malaria has been changing. Recent data have shown declining of malaria transmission, morbidity and mortality in some endemic African countries where malaria control interventions were implemented, which implies that some of the areas previously defined as “high stabile malaria transmission” have changed into moderate or low transmission areas”. Due to the changing epidemiology of malaria, in the future pre-travel advice and recommendations could be more often based on stand-by treatment rather than malaria chemoprophylaxis. Regarding the cause of human malaria, there is the fifth human malaria parasite: Plasmodium knowlesi, a primate parasite that is increasingly recognized as a cause of human malaria in parts of South East Asia. There are some similarities between P. knowlesi and P. malariae: the trophozoite, shizont and gametocyte stages of P. knowlesi are morphologically indistinguishable from those of P. malariae by microscopy and uncomplicated cases of P. knowlesi respond to Chloroquine. On the other side, the 24-h asexual life cycle of P. knowlesi is the shortest of all the known human and nonhuman primate malarias. Because of daily shizont rupture and a potentially rapid increase in parasite load, delay in accurate diagnosis and treatment may cause severe, fatal malaria. It is recommended that symptomatic malaria with hyperparasitemia and parasite morphology resembling that of P. malariae is to be diagnosed as P. knowlesi in Malaysia and in the areas of Southeast Asia that are inhabited by the long and pig-tailed macaques. Drug resistance to available antimalarial drugs is an increasing problem throughout the world. In some countries multidrug resistance threatens to make malaria untreatable. Artemisinin based combination treatments (ACTs) are now recommended as first-line drugs for falciparum malaria throughout the world, with different ACTs incorporating various artemisinins and patner drugs. Dyhidroartemisinin/piperaquine is a major new ACTs developed in China. Dihidroartemisinin is the common metabolite of artesunate and artemether, and piperaquine is a slowly eliminated bisquinoline which retains activity against multi-drug resistant Plasmodium falciparum and is also effective against Plasmodium vivax.

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