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  • Title: "Pseudo-resistant" malaria in tropical countries.
    Author: Carme B.
    Journal: Lancet; 1992 Oct 10; 340(8824):896-7. PubMed ID: 1357307.
    Abstract:
    Tropical disease physicians are challenged by drug-resistant Plasmodium falciparum. Well-documented effects of resistance on malaria morbidity and mortality among people in tropical countries do not exist. Observed resistant malaria in these countries may consist of true and false positive cases particularly in urban and suburban areas of sub-Saharan Africa. WHO recommends systematic treatment with an antimalarial drug for persons with fever in these areas. Yet clinicians should have more information to diagnose malaria. Fever may be due to something other than malaria or to malaria but not due to resistance. So clinicians who cannot confirm malaria should modify antimalarial treatment. If trophozoites are still present, clinicians tend to claim resistance but false positives can occur if the blood smear is thick. A low trophozoite load may even indicate weak resistance. Thus they need to distinguish between true treatment failure (clinical resistance) or clinical cure with low residual parasite load (parasitological resistance). In sub-Saharan Africa, amino-4-quinoline resistance occurs often but the degree of resistance is not high. Indeed its frequency is slowing. So clinicians should use these inexpensive and well-tolerated drugs for uncomplicated malaria among natives. As false positives increase, so will the number of people who undergo unnecessary treatment thus increasing the chances of drug toxicity, overdose, or complications from home IV therapy. Reliable studies indicate that antimalarials may be clinically effective and malaria-related mortality low in as much as 70% of P. falciparum strains considered to be resistant. National programs should see to improved competence, technical ability, and their authority to stop this harmful trend. They should also have power over continuous training, health education, assessment of drug resistance and iatrogenic disease, and biological quality controls for detection of P. falciparum.
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