ABSTRACT
-The available antimalarial drugs for the treatment of Plasmodium falciparum malaria
during pregnancy are potentially toxic, expecially in the presence of red blood cells
(RBC) defects. We describe a case of chloroquine-resistant malaria by P. falciparum
in a pregnant woman with glucose-6-phosphate dehydrogenase (G6PD) deficiency successfully
treated with pyrimethamine followed by mefloquine administration. The susceptibility
of P. falciparum to chloroquine and mefloquine was assessed by an in vitro test before
treatment. Pyrimethamine and mefloquine were administered at the 18th and 22nd week
of pregnancy, respectively. Mefloquine concentrations were monitored in the mother's
blood at 2, 4, 8, 12, 24 and 48 hr after the administration to define effective blood-drug
concentrations. Blood smear examination was negative after 48 hr post mefloquine treatment.
No hystologic lesions of the placenta were observed. The newborn presented normal
clinical parameters. The administration of pyrimethamine prevented massive placental
infection, thus permitting the fetus to achieve suitable gestational age for further
treatment with mefloquine to eradicate P. falciparum malaria without deleterious effects
to the newborn. Subsequent studies could contribute to define safe administration
of mefloquine in G6PD-deficient pregnant woman.
KEYWORD
Plasmodium falciparum - mefloquine - glucose-6-phosphate dehydrogenase - pregnancy
