brewing problem. Malaria, which is carried by mosquitoes, is more difficult to conquer Cambodia
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Malaria fighters nightmare appeared in the western Cambodia. Parasites with resistance to the most effective drugs in the world. The new discovery is a blow to hopes that humanity could eliminate the disease in the coming decades. It also highlights, say the researchers, the urgent need to fight against muscular malaria along the Thai-Cambodian border and more action around the world against the misuse of drugs against malaria.
Artemisinin, derived from the plant Artemisia, is a key tool in the global fight against malaria. It kills malaria parasites especially quickly, which gives them less chance to develop resistance. As a bulwark against the resistance, doctors combine artemisinin-based drugs with a second drug, such as mefloquine, so that any parasites that are beyond treatment are killed by the other.
In Cambodia, however, the use of artemisinin-based drugs without saving a second drug is widespread. Many people rely on local drug dealers who sell pills one at a time - many of them counterfeit, says Duong Socheat of the National Centre for Parasitology, Entomology and fight against malaria in Phnom Penh. The incomplete treatment is the perfect recipe for the development of resistant strains, he said.
Scattered reports of cases of artemisinin-resistant malaria began to appear in the region over the past decade, and the researchers carefully watched for signs that resistant strains can be striking. Socheat, with Arjen Dondorp of Mahidol University in Bangkok and other colleagues took a look more closely at the situation. They studied 40 patients with malaria in Pailin, western Cambodia and compared them with 40 patients in Wang Pha in northwestern Thailand, a region where artemisinin-based therapies are known to be effective.
In an article to be published tomorrow The New England Journal of Medicine , the team reports that it took much longer for the drugs to clear parasites from the blood of patients Pailin - a median of 84 hours compared to 48 hours in Wang Pha. The rapid clearance is the mark of artemisinin, "the situation is very worrying," says Dondorp. Although the double blow of the combined therapy can even cure patients, allowing parasites to survive a day or two sheets of therapy "very vulnerable to the continued development of resistance," he said, which could lead to even more dangerous strains.
Another article in the same issue with evidence of resistance: Socheat, Harald Noedl Medical University of Vienna, and Wichai Satimai the Ministry of Public Health in Nonthaburi, Thailand, reported that in laboratory tests, parasites patients in Cambodia and Thailand are less susceptible to artemisinin that are parasites of patients in western Thailand and Bangladesh.
Carlos Campbell of the Program for Appropriate Technology in Health in Seattle, Washington, who was not involved in either study, said in a commentary accompanying the results leave no doubt that there is resistance artemisinin in western Cambodia. The World Health Organization has already begun an intense campaign in the region to contain the emerging threat by first intensive treatment all cases of malaria in the region and try to eliminate the use of monotherapies based artemisinin. Even if this campaign succeeds, Noedl said it is only a matter of time until resistance develops elsewhere. "It happened once and it can happen again," he said.
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