Abstract
Antik çağlardan beri bilinen ve insanoğlunun sürekli mücadele ettiği bir hastalık olan sıtma, günümüzde önemli bir morbidite ve mortalite nedeni olarak güncelliğini korumaktadır. Türkiye'de 2010 yılından bu yana yurtiçinde herhangi bir vaka görülmemekle birlikte, her yıl yaklaşık 200-250 civarında yurt dışından kaynaklanan sıtma vakası görülmektedir. 1970'lerde klorokin direncinin ortaya çıkmasından bu yana yıllar içinde birçok paraziter ilaca karşı direnç gelişmiştir. Artemisinin direnci, DSÖ tarafından 2013 yılında P. falciparum sıtmasına bağlı olarak Kamboçya, Laos, Myanmar, Tayland ve Vietnam'da rapor edilmiş olup, son zamanlarda Güney Afrika ve Ruanda'da da direnç bildirilmiştir. Direnç gelişiminin parazitte tespit edilen Kelch 13 mutasyonuna bağlı olduğu ve bu durumun klirensin gecikmesine yol açtığı gösterilmiştir. DSÖ verilerine göre artemisinin dirençli P. falciparum suşları ile enfekte hastaların tedavisinde artemether-bazlı kombine tedavi halen etkilidir ancak olası tedavi yanıtsızlığı DSÖ tarafından titizlikle takip edilmektedir. Olgumuz, 28 günde iki kez artemether bazlı kombine tedaviye rağmen üçüncü nüksü olması, kinin ve doksisiklin tedavisi sonrasında ise kalıcı tedavi yanıtı ile dikkat çekicidir.
Keywords
Supporting Institution
Yok
Project Number
Yok
References
- World Health Organization (WHO). Malaria Overview 2021. Accessed date: 10 November 2022: https://www.who.int/news-room/fact-sheets/detail/malaria#:~:text=The%20estimated%20number%20of%20malaria,malaria%20deaths%20in%20the%20Region
- T.C Sağlık Bakanlığı. Sıtma Vaka Yönetim Rehberi 2019. Accessed date: 10 November 2022: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-sitma/ rehberler
- Kuman HA, Altıntaş N. Plasmodiumlar, Protozon Hastalıkları. İzmir. Ege Üniversitesi Basımevi, 1996.
- Wyler DJ. Plasmodium and babesia. In: Gorbach SL, Barlett JG, Neil R, Blacklow NR, eds. Infectious Diseases. 1st ed. Philadelphia. W B Saunders, 1998:2407.
- Fairhust RM, Wellems TE. Plasmodium Species (malaria). In: Mandel GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 7th ed. Philadelphia. Elsevier Churchill Livingstone, 2010:3437-56.
- World Health Organization (WHO). WHO Guidelines for malaria 2022. Accessed date: 15 November 2022: https://reliefweb.int/report/world/who-guidelines-malaria-3-june-2022
- Wicht KJ, Mok S, Fidock DA. Molecular mechanisms of drug resistance in plasmodium falciparum malaria. Annu Rev Microbiol. 2020;74:431-54.
- Su XZ, Lane KD, Xia L, Sá JM, Wellems TE. Plasmodium genomics and genetics: New ınsights into malaria pathogenesis, drug resistance, epidemiology, and evolution. Clin Microbiol Rev. 2019;32(4):e00019-19.
- Uwimana A, Umulisa N, Venkatesan M, Svigel SS, Zhou Z, Munyaneza T, et al. Association of ploasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: An open-label single- arm, multicentre therapeutic efficacy study. Lancet Infect Dis. 2021;21(8):1120-8.
- World Health Organization (WHO). Status report on artemisinin and ACT resistance—September 2015. Accessed date: 12 December 2022:https://apps.who.int/ iris/bitstream/handle/10665/338493/WHO-HTM-GMP-2015.4-eng.pdf?sequence=1&isAllowed=y
- White NJ. Quinghaosu (artemisinin): The price of success. Science. 2008;320(5874):330-4.
- Centers for Disease Control and Prevention (CDC). Traveler’s Health, CDC Yellow Book. Accessed date: 18 December 2022: https://wwwnc.cdc.gov/travel/ yellowbook/2020/preparing-international-travelers/ yellow-fever-vaccine-and-malaria-prophylaxis-information-by-country/burkina-faso#footnotes
Abstract
Malaria, a disease known since ancient times and constantly struggled by human beings, still maintains its currency as an important cause of morbidity and mortality today. Although no domestic cases have been observed in Turkey since 2010, around 200-250 malaria cases originating from abroad are observed every year. Resistance to many parasitic drugs has developed over the years since chloroquine resistance emerged in the 1970s. Artemisinin resistance was reported by WHO in Cambodia, Laos, Myanmar, Thailand and Vietnam in 2013 due to P. falciparum malaria, and resistance has been reported also in South Africa and Rwanda recently. It has been shown that resistance development is due to the Kelch 13 mutation detected in parasite and this leads to delayed clearance. According to WHO data, artemether-based combined therapy is still effective in the treatment of patients infected with artemisinin-resistant P. falciparum strains, but possible treatment unresponsiveness is followed meticulously by WHO. Our case is remarkable for its third recurrence despite artemether-based combined therapy twice in 28 days, and its persistent treatment response after quinine and doxycycline treatment.
Project Number
Yok
References
- World Health Organization (WHO). Malaria Overview 2021. Accessed date: 10 November 2022: https://www.who.int/news-room/fact-sheets/detail/malaria#:~:text=The%20estimated%20number%20of%20malaria,malaria%20deaths%20in%20the%20Region
- T.C Sağlık Bakanlığı. Sıtma Vaka Yönetim Rehberi 2019. Accessed date: 10 November 2022: https://hsgm.saglik.gov.tr/tr/zoonotikvektorel-sitma/ rehberler
- Kuman HA, Altıntaş N. Plasmodiumlar, Protozon Hastalıkları. İzmir. Ege Üniversitesi Basımevi, 1996.
- Wyler DJ. Plasmodium and babesia. In: Gorbach SL, Barlett JG, Neil R, Blacklow NR, eds. Infectious Diseases. 1st ed. Philadelphia. W B Saunders, 1998:2407.
- Fairhust RM, Wellems TE. Plasmodium Species (malaria). In: Mandel GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 7th ed. Philadelphia. Elsevier Churchill Livingstone, 2010:3437-56.
- World Health Organization (WHO). WHO Guidelines for malaria 2022. Accessed date: 15 November 2022: https://reliefweb.int/report/world/who-guidelines-malaria-3-june-2022
- Wicht KJ, Mok S, Fidock DA. Molecular mechanisms of drug resistance in plasmodium falciparum malaria. Annu Rev Microbiol. 2020;74:431-54.
- Su XZ, Lane KD, Xia L, Sá JM, Wellems TE. Plasmodium genomics and genetics: New ınsights into malaria pathogenesis, drug resistance, epidemiology, and evolution. Clin Microbiol Rev. 2019;32(4):e00019-19.
- Uwimana A, Umulisa N, Venkatesan M, Svigel SS, Zhou Z, Munyaneza T, et al. Association of ploasmodium falciparum kelch13 R561H genotypes with delayed parasite clearance in Rwanda: An open-label single- arm, multicentre therapeutic efficacy study. Lancet Infect Dis. 2021;21(8):1120-8.
- World Health Organization (WHO). Status report on artemisinin and ACT resistance—September 2015. Accessed date: 12 December 2022:https://apps.who.int/ iris/bitstream/handle/10665/338493/WHO-HTM-GMP-2015.4-eng.pdf?sequence=1&isAllowed=y
- White NJ. Quinghaosu (artemisinin): The price of success. Science. 2008;320(5874):330-4.
- Centers for Disease Control and Prevention (CDC). Traveler’s Health, CDC Yellow Book. Accessed date: 18 December 2022: https://wwwnc.cdc.gov/travel/ yellowbook/2020/preparing-international-travelers/ yellow-fever-vaccine-and-malaria-prophylaxis-information-by-country/burkina-faso#footnotes
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Reports |
| Authors | |
| Project Number | Yok |
| Publication Date | August 31, 2023 |
| Submission Date | January 4, 2023 |
| Published in Issue | Year 2023 Volume: 25 Issue: 2 |
Cite
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.