Mechanism, Consequences And Ways Of Detecting Drug-resistant Malaria Parasites
Malaria parasites need two enzymes DHPR (dihydrofolate reducctase) and DHPS (dihydropteroate synthetase) in the metabolism to produce folic acid to survive. Drugs such as sulfadoxine, pyrimethamine and proguanil (cycloguanil) inhibit the DHFRN and DHPS enzymes, resulting in the parasite being killed.
The parasite will be resistant to the above drugs by a mutation where the gene encoding DHFR, DHPS makes these drugs unable to attach to DHFR, DHPS and thus loses its effect on the parasite.
Chloroquine is connected to one or more transportable glycoproteins (P-glycoproteins) located in the intestinal vacuole membrane of the parasite and causes chloroquine to be rapidly discharged from the parasite, not accumulating enough concentrations to cause toxicity.
What are the consequences of drug-resistant malaria parasites?
If the level of resistance is low and the incidence of malaria is low, the consequences of resistance will not be apparent
But then symptoms appear again, usually after more than 2 weeks, anemia is worse and patients often carry gametes. However, patients and physicians often think that they are infected again a second time (re-infection)
At this stage, if the effectiveness of the drug is not assessed, resistance will not be detected Gradually the level of resistance will get worse and the gap between the time of recovery and the relapse of the disease will become shorter.
At this time, the incidence of malaria in the region will increase and the risk of death will be greater.
How to detect drug-resistant parasites?
Previously, when assessing the phenomenon of drug resistance, people were only interested in the change of the number of parasites in the blood under the effect of malaria drugs (parasite - malaria relation), shown by Four levels: sensitivity (S), resistance level I (R1), resistance level II and resistance level III.
Currently, to detect drug resistance, the effectiveness of antimalarial drugs is assessed considering the clinical course and density of the malaria parasite, expressed through three monitoring results: treatment failure early (ETF), treatment of late failure (LTF) and good clinical and parasitic response (ACPR).
Monitoring the effectiveness of antimalarial drugs is an important content in the prevention of malaria, as a basis for the selection of treatment regimen as well as for the development and revision of national drug policies. fever.
Evaluation of the effectiveness of malaria drugs should be conducted in each country where the disease is endemic and on a regular basis at sentinel sites
In addition to evaluating the therapeutic efficacy of antimalarial drugs clinically and parasitically (in vivo technique), it was also evaluated changes in parasite sensitivity to malaria drugs (technical in vitro) as well as detect mutations in genes (molecular markers)
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