In vitro and in vivo response of Plasmodium falciparum to Chloroquine in Pregnancy at Kilifi District of Kenya.

ONJUA PROFOYIEKEJB, OTIENO DRODAWAFRANCISXAVIER. "In vitro and in vivo response of Plasmodium falciparum to Chloroquine in Pregnancy at Kilifi District of Kenya.". In: E.Afr. Med J 69:306,1992 Comment in: East Afr Med J. 1992 Jun;69(6):297. Elsevier; 1992.


In a malaria-endemic area of the Coast of Kenya with chloroquine resistant Plasmodium falciparum, we determined the prevalence and density of falciparum infection in gravid women and assessed the in vivo and in vitro parasite response to a regimen of chloroquine 25 mg/kg body weight divided over three days. P. falciparum infections were present in 65 (21.7%) of 300 pregnant women. The proportion of primigravidae who were parasitaemic was 41.8% which was significantly higher than that of the multigravidae (17.1, P less than 0.01). Primigravidae did not show a significantly higher mean parasite density than the multigravidae. The in vivo tests showed that 45.9% of all the P. falciparum infections were resistant to chloroquine predominantly at RI and RII levels with percentages 36.1% and 8.2%, respectively. PIP: At the antenatal clinic of Kilifi District Hospital in the Coast Province of Kenya, researchers enrolled 300 pregnant volunteers 15-32 years olds, living in the district to screen and treat then for Plasmodium falciparum infection and to follow those with parasitemia on days 0, 1, 2, 14, 17, 21, and 28. They also conducted in vitro studies to determine resistance to chloroquine. They combined in vivo and in vitro study took place between November 20, 1988 and January 17, 1989. 65 women (21.7%) had P. falciparum in their peripheral blood smear. Primigravidae were more likely to be parasitemia than were multigravidae (41.8% vs. 17.1%; p .001). Their mean parasite density was also higher but not significantly so. Parasite density fell consistently with rising parity. Malaria infections in 54.1% of the women responded to 25 mg/kg chloroquine. the remaining 45.9% (28) of cases exhibited in vivo resistance, especially at RI an RII levels (36.1% and 8.2%, respectively). Primigravidae were more likely to experience failure to clear parasites by day 7 than multigravidae. Further, among women experiencing a parasitemia on day 7, parasites tended to reappear on day 14 and 21 in primigravidae. Initial parasite density did not affect clearance of parasites. Primigravidae continued to have a higher level of parasitemia throughout treatment than did multigravidae. It took at least 24 hours for the chloroquine to be completely absorbed thus the mean level of parasitemia decreased sharply between 0-2 days. Amodiaquine induced a parasitemia in 89.3% (25 cases) of the chloroquine resistant infections. Even though the 3 remaining cases with parasitemia received amodiaquine treatment, clinicians administered Fansidar, resulting in a clearing of parasitemia in 7 days. 34.8% of in vitro parasite cultures were resistant to chloroquine. The reduced ability of pregnant women to clear parasitemia likely explained the lower level of in vitro resistance.




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