疟原虫的耐药性、未来疟疾管理策略和药用植物的重要性

H. S. Cheema, Mitra Pal Singh
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引用次数: 1

摘要

疟疾是人类最常见和最具破坏性的寄生虫病,每年夺去100万至200万人的生命。除青蒿素外,对大多数现有抗疟药类别的耐药性已经出现,导致疟疾相关死亡率出现新的高峰,特别是在非洲。自20世纪50年代末以来,东南亚一直是恶性疟原虫耐药性发展的焦点,当时在泰国-柬埔寨边境发现了第一例氯喹耐药性。尽管早在南美洲就记录了奎宁耐药性的首次发生,但东南亚氯喹耐药性的出现标志着疟疾历史上一个新时代的开始。随着氯喹耐药性的发展,泰国和非洲国家转而使用磺胺嘧啶-乙胺嘧啶组合作为一线药物。SP随后被甲氟喹取代。由于对这种新药的耐药性迅速发展,青蒿素在20世纪90年代中期作为一种联合药物被引入。在世界几个地区已经发现了青蒿素耐药性,如果这种情况继续下去,疟疾控制行动可能会受到危害,因为目前没有替代的抗疟疾药物。本综述的目的是总结目前关于耐药疟疾的知识状况,并概述抗生素耐药性的演变趋势,例如其成因、不同地理区域的现状、分子标记、防止耐药疟疾出现和传播的后果以及药用植物在发现新型抗疟药物中的作用。
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Drug resistance in plasmodium, future malaria management strategies and importance of medicinal plants
Malaria, the most common and destructive parasite disease in humans, take the lives of 1-2 million people every year. With the exception of artemisinin, resistance to most of the existing antimalarial agent classes has arisen, resulting in a new spike in malaria-related mortality, particularly in Africa. Southeast Asia has been a focal point for the development of drug resistance in Plasmodium falciparum since the late 1950s, when the first example of chloroquine resistance was discovered along the Thai-Combodian border. Despite the fact that the first incidence of quinine resistance had been documented far earlier in South America, the emergence of chloroquine resistance in Southeast Asia signalled the beginning of a new era in malaria history. Following the development of chloroquine resistance, Thailand and African countries shifted to a sulphadoxine-pyrimethamine combination as their first-line medication (SP). SP was subsequently superseded by mefloquine. Because of the quick development of resistance to this new medicine, artemisinin was introduced as a combination drug in the mid-1990s. Artimisinin resistance has been identified in several parts of the world, and if it continues, malaria control initiatives could be jeopardised, as there is now no substitute antimalarial medicine available. The purpose of this review is to summarise the current state of knowledge about drug-resistant malaria and to sketch out the evolving trends of resistance to antibiotics, such as its causal factors, current situation in various geographical areas, molecular markers, consequences for preventing the emergence and spread of drugresistant malaria, and the role of medicinal plants in the discovery of novel antimalarials.
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