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. 2016 Dec 28;95(6 Suppl):35-51.
doi: 10.4269/ajtmh.16-0171. Epub 2016 Oct 5.

Diagnosis and Treatment of Plasmodium vivax Malaria

Affiliations

Diagnosis and Treatment of Plasmodium vivax Malaria

J Kevin Baird et al. Am J Trop Med Hyg. .

Abstract

The diagnosis and treatment of Plasmodium vivax malaria differs from that of Plasmodium falciparum malaria in fundamentally important ways. This article reviews the guiding principles, practices, and evidence underpinning the diagnosis and treatment of P. vivax malaria.

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Figures

Figure 1.
Figure 1.
Clinical reports of chloroquine-resistant Plasmodium vivax. Red icons highlight areas of chloroquine-resistant parasites defined by greater than 10% recurrence (and lower 95% confidence interval [CI] > 5%) by day 28 with or without measurement of chloroquine drug concentration; dark orange diamonds locate area suggestive of resistance as defined by 5–10% recurrence by day 28, confirmed with adequate chloroquine drug concentrations; light orange icons locate sites of possible resistance as defined by less than 5–10% recurrence by day 28 but with lower 95% CI < 5% by day 28, without drug concentrations. Yellow icons represent case reports. Details of clinical trials are provided in Supplemental Annex A.
Figure 2.
Figure 2.
Clinical reports of chloroquine-sensitive (CQS) Plasmodium vivax. CQS was defined as < 5% recurrence by day 28, no early administration of primaquine, and all patients from symptomatic clinical presentation. Yellow icons represent studies before 2007, orange icons studies between 2007 and 2012. Details of clinical trials are provided in Supplemental Annex A.
Figure 3.
Figure 3.
Risk of recurrence at the end of the study following very low-dose primaquine (PQ) (total dose ≤ 2.5 mg/kg), low-dose PQ (total dose> 2.5 mg/kg to < 5.0 mg/kg), high-dose PQ (total dose> 5.0 mg/kg). Indonesia and Papua New Guinea [closed circles]; Thailand and Vietnam (open circles); South and Central America (open squares); Indian subcontinent, Middle East, and Horn of Africa (open diamonds); and Korea and China (closed diamonds). The U.S. studies of induced malaria and returning soldiers are categorized according to origin of infecting strain.
Figure 4.
Figure 4.
Forest plot of the effectiveness of low-dose primaquine in studies with a control arm. * Indian subcontinent, ^ United States (Korea), ^^ United States (Chesson), # Thailand, ## Indonesia, + Ethiopia.
Figure 5.
Figure 5.
Forest plot of the effectiveness of high-dose primaquine in studies with a control arm. * Indian subcontinent, ## Indonesia.
Figure 6.
Figure 6.
National malaria treatment guidelines and recommendations concerning primaquine anti-relapse therapy and G6PD screening, reprinted with permission of World Health Organization.

References

    1. World Health Organization . Guidelines for the Treatment of Malaria. 3rd edition. Geneva, Switzerland: WHO; 2015.
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    1. World Health Organization . Malaria Microscopy Quality Assurance Manual. Manila, Philippines: WHO, Western Pacific Regional Office; 2009.
    1. World Health Organization . Basic Malaria Microscopy. 2nd edition. Geneva, Switzerland: WHO; 2010.
    1. Greenwood BM, Armstrong JR. Comparison of two simple methods for determining parasite density. Trans R Soc Trop Med Hyg. 1991;85:186–188. - PubMed

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