MALÁRIA NO AMAPÁ. OBSERVAÇÕES SÔBRE O COMPORTAMENTO ANÔMALO DO PLASMODIUM FALCIPARUM EM FACE DO TRATAMENTO PELAS 4-AMINOQUINOLINAS

Abstract
The authors describe 99 cases of infection by Plasmodium falciparum that responded abnormally to curative and suppressive treatment with Amodiaquin associated to Primaquine (Camoprim) and to treatment with Amodiaquin alone. The cases occurred in two industrial villages belonging to "Indústria e Comércio de Minérios" - ICOMI - a manganese mining company operating in Macapá, Território Federal do Amapá, Brazil. One of the villages has 1,97 4 inhabitants (Serra do Navio) and the other 1,561 (Vila Amazonas). The 99 cases were observed among 440 cases made up by the employees or relatives of employees, who suffered one or more attacks of malaria by P. vivax or P. falciparum between July 1, 1961 and February 28, 1962 and followed through March, 1962 at Serra do Navio and May, 1962 at Vila Amazonas. The problem seems identical with those observed by Moore and Lanier (1961) in Colombia and by Silva et ai.(1961) in Brazil. Both villages are situated in the malaria endemic zone and have suffered the influence of their situation due to intense interchange of their populations with those living in their vicinity but out of the company's boundaries, in a region where many breeding places of Anopheles darlingi are found. Of the 440 patients until February 28, 1962, 243 were infected by P. vivax, 227 by P. falciparum and 30 by both. Of the patients infected by P. falciparum 99 showed evidence of resistance or tolerance to Amodiaquin, with the following results: 53 resisted doses of 4-aminoquinolines usually considered to bring about radical cure the majority of which were treated, in addition, with weekly doses of Camoprim (2 pills). On the whole, 49 patients from Vila Amazonas (52. 8 per cent of P. falciparum cases observed in the village) and 50 patients from Serra do Navio (37. 3 per cent) showed signs of resistance to curative and suppressive treatment. Plasmodium falciparum caused one or more new attacks (relapses or new infections) in 35 per cent of infections whereas P. vivax caused only 19 per cent; there was, therefore, an inversion in what is expected of these two species of Plasmodia regarding use of 4-aminoquinolines. There were 38 cases in which infection by P. falciparum occurred despite suppressive treatment with two pills of Camoprim given once a fortnight. In 30 instances P. falciparum infection did not respond to suppressive treatment with weekly doses of Camoprim, of which in 8 cases the drug was administered before the primary attack and between attacks in 22. Judging from the data exposed it appears to be very likely that the 4-aminoquinoline resistant race of Plasmodium falciparum described by Silva et ai. (1961) in Brazil is widely spread.

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