K. Chotivanich et al., The mechanisms of parasite clearance after antimalarial treatment of Plasmodium falciparum malaria, J INFEC DIS, 182(2), 2000, pp. 629-633
Studies were conducted to determine how malaria parasites are cleared from
the blood after antimalarial treatment, Neither artesunate nor quinine decr
eased parasitized red cell deformability or increased antibody binding, In
acute falciparum malaria, ring-infected erythrocyte surface antigen (RESA)
was observed in erythrocytes without malaria parasites (RESA-red blood cell
[RBC]), indicating prior parasitization. In uncomplicated malaria, RESA-RB
C numbers increased significantly (P = .002) within 24 h of starting artesu
nate but rose much more slowly (7 days) after quinine treatment, In severe
malaria, RESA-RBC increased significantly (P = .001) within hours of starti
ng artesunate but not with quinine treatment (P = .43), RESA-RBCs were not
produced after drug treatment of malaria parasite cultures in vitro. Rapid
malaria parasite clearance after treatment with artemisinin derivatives res
ults mainly from the extraction of drug-affected parasites from host erythr
ocytes-presumably by the spleen. This explains why the fan in hematocrit af
ter treatment of hyperparasitemia is often less than that predicted from lo
ss of parasitized cells.