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Tjokrosonto, S. 1998 Studies on the heterogeneity of response of the Plasmodium falciparum malaria parasite to different drugs with particular reference to Irian Jaya, Indonesia, PhD Dissertation, London School of Hygiene and Tropical Medicine.
    © Tjokrosonto, S., 1988. Use of any part of this thesis for any purpose must be acknowledged.

Abstract

Jayapura, Irian Jaya, is an area of mesoendemic malaria where infections with P.falciparum and P.vivax are very common. There is a high morbidity from malaria and a proportion of infections are resistant to available drugs such as chloroquine. In vitro testing of 42 isolates of P.falciparum showed that 90.5% showed resistance to chloroquine. Sensitivity in vitro to the following pairs of drugs were significantly correlated : chloroquine and amodiaquine, mefloquine and quinine, quinine and sulfadoxine/pyrimethiamine. Studies on responses to quinine in vivo showed a normal response in 28/33 patients (84.9%). The in vitro response to quinine did not reliably predict the in vivo response. Isolates of P.falciparum in Jayapura showed evidence of heterogeneity in drug response. The most common pattern of sensitivity (42.1%) is R-S-S-S indicating resistance to chloroquine and sensitivity to amodiaquine, quinine and mefloquine. The second most common pattern (36.8%) is sensitivite to all drugs (S-S-S-S). In laboratory studies, an isolate of P.falciparum from West Africa was shown to contain clones with differing chloroquine responsiveness, and the more chloroquine-resistance had higher growth rates. The parasite isolates made from the patients in the study were tested using a series of monoclonal antibodies in the indirect fluorescent antibody test. Evidence of the occurrence of serogroups I, V and VI was obtained. Immune human sera from Jayapura inhibited merozoire invasion in vitro. They were also capable to a lesser extent of inhibiting intracellular growth. Immune sera from Jayapura were more inhibitory to the FCQ-27 strain originating from the neighbouring country, Papua New Guinea, than to 2 strains from other areas. It is recommended that the increase of chloroquine resistance and sensitivity to other antimalarials in Indonesia should be continuously monitored. Extended and more definitive studies are required in attempt to obtain greater accuracy in antigen serotyping and on growth inhibition of P.falciparum in Indonesia by immune sera.


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