МОНИТОРИНГ ЭФФЕКТИВНОСТИ ДЕЛАГИЛА (ХЛОРОХИН) В ОТНОШЕНИИ ЗАВОЗНЫХ ШТАММОВ PLASMODIUM VTVAX

The efficiency of P.vivax malaria treatment with delagil (chloroquine) was evaluated in 122 patients, including 82 cases in Moscow and the Moscow region. The origin of the cases was malaria endemic areas in Asia, Africa, the Pacific Region, South America, and Transcaucasia. Forty other cases were imported malaria cases (secondary to imported ones), detected in Moscow and the Moscow region. Standard treatment with delagil (2.5 g) resulted in clinical improvement during 3 days in the majority of cases. Initial signs of degradation of asexual stages of P.vivax - kernels of nucleus, refinement of cytoplasm and its vacuolization, aggregation of pigment in isolated instances, its pushing out from cytoplasm - were observed after 1-2 hours after administration of delagil. Thereafter, parasite degradation was increasing, and it disappeared within 48 hours. Disappearance of fever slowed down in a few cases. However, degradation of parasites occurred during the same period among the rest of cases. It can not be excluded that fever was determined by the pyrogenic effect of remnants of degraded parasites and by the products of destroyed infected erythrocytes. It is probable that the findings of gametocytes, not completely degraded after disappearance of asexual forms in conjunction with prolonged fever, could result in a wrong conclusion of drug resistance. Negative results of microscopy and nested PCR on the last day of treatment, as well as in the following 10 days and absence of complains during 45 days, suggest the absence of resistance to delagil in P.vivax strains imported from different regions of the world. It is also probable that the literature on P.vivax resistance to chloroquine is limited to sporadic cases.