Jean Paul Lepers

Efficacy of a 3-day oral regimen of a quinine-quinidine-cinchonine association (Quinimax®) for treatment of falciparum malaria in Madagascar

In the search for an effective, safe and field-adapted alternative to chloroquine for therapy of chloroquine-resistant Plasmodium falciparum infections in Africa, a 3-d oral regimen of Quinimax (an association of quinine, quinidine and cinchonine) was evaluated in 35 individuals with P. falciparum in Madagascar, an area with chloroquine resistance. 63% of the parasite strains isolated were resistant in vitro to chloroquine, and 59% of the infections were present despite previous chloroquine intake. Three daily oral doses of 10 mg/kg Quinimax for 3 d cleared parasitaemia and improved clinical status in all subjects. Mean parasite and fever clearance times were 51.7 and 37.4 h, respectively. All patients were aparasitaemic at the end of the 7-d follow-up. When formulating therapy guidelines, the 3-d Quinimax regimen should be considered as a valuable alternative to chloroquine for treating falciparum malaria in African areas with clinical resistance to chloroquine.

Efficacy of a loading dose of oral chloroquine in a 36-hour treatment schedule for uncomplicated plasmodium falciparum malaria.

The efficacy of a loading dose of 20 mg of chloroquine per kg of body weight per os given at intervals during the first day was evaluated in 27 patients in Madagascar with Plasmodium falciparum malaria. The conventional regimen of 25 mg/kg over 3 days (schedule 1) was thus compared with a regimen of 30 mg/kg over 2 days (schedule 2; one dose of 10 mg/kg followed by two doses of 5 mg/kg at 6-h intervals on the first day and two doses of 5 mg/kg at 12-h intervals on the second day) in terms of their clinical and parasitological efficacies, tolerance, and drug concentration-time curves. At 24 h schedule 2 gave higher chloroquine levels in blood, which induced a more rapid decrease in parasitemia. The time required for a 50% decrease in the initial parasitemia was shorter in patients on schedule 2 (14.3 +/- 1.6 h) than it was in patients on schedule 1 (35.5 +/- 5.4 h; P less than 0.01). Moreover, negative blood smears were obtained more rapidly with schedule 2 (50.8 +/- 3.7 h) than with schedule 1 (72 +/- 8.7 h). As predicted by the drug concentration-time curve, no high, potentially toxic peak drug concentration appeared and no adverse effects were observed with the loading dose regimen (schedule 2). These findings support the idea that a loading dose of 20 mg/kg given at intervals during the first 12 h is well tolerated and can be used to obtain a more rapid decrease in parasitemia and to shorten the treatment time of uncomplicated chloroquine-susceptible falciparum malaria in the field.

Longitudinal study of the cellular response to Pf155/RESA and circumsporozoite protein in Madagascar

In a community follow-up conducted in the Central Highlands of Madagascar, the cellular responses to synthetic peptides from the immunodominant regions of Pf155/RESA and the repeat region of the circumsporozoite protein were studied. Seasonal variations of the T cell response were measured at the individual level; the relationship between this response and the presence of parasites in blood was assessed; the question of the possible protective value of the lymphocyte proliferation in presence of a specific antigen was addressed.

Pefloxacin for Falciparum Malaria: Only Modest Success

The spread of chloroquine-resistant Plasmodium falciparum strongly indicated the need for new safe and effective antimalarial drugs. In addition to their antibacterial action, fluoroquinolone antib...

Epidémiologie de l'infection par le virus de l'hépatite C au Vietnam

Resume La prevalence des anticorps anti-VHC a ete etudiee sur 1 467 serums provenant de sujets recrutes a Ho Chi Minh Ville (HCMV). Ces serums ont ete selectionnes parmi les groupes suivants : un groupe temoin (453 sujets), un groupe a risque (374), un groupe de sujets presentant une hepatopathie (479) et enfin un groupe de donneurs de sang (100) et de membres du personnel hospitalier (61). La prevalence de la contamination par le VHC dans la population generale est de 1,8 %. Les prevalences tres elevees observees dans les groupes de toxicomanes (96,2 %), de sujets VIH positifs (73,4 %) et de malades ayant recu une transfusion sanguine (50 %) tendent a demontrer que le mode principal de contamination est la voie parenterale. Chez les sujets atteints de maladies sexuellement transmissibles et chez les prostituees, la prevalence du VHC est significativement plus elevee que chez le groupe temoin (p