Dear Editor,
I have gone through the paper titled. “Resurgence of MT Malaria amongst troops serving in the North East”, Medical Journal of Armed Forces India 1994; 50 : 5-9 and critics reply published as letter to Editor in MJAFI, 50; 4 : 306-7.
I want to share some of my experience with you. While I am fully in agreement with Lt Col A Banarjee and author's reply thereto (Wg Cdr SK Krishnan), I want to make two observations.
While agreeing with the probability of Chloroquin resistance in MT malaria, I would like to draw your attention to the possibility of both Chloroquin and Quinine resistance in MT malaria and the bizaree presentation.
There was a resurgence of MT malaria in 1973-74 in troops located in Arunachal Pradesh and Mizoram particularly in paramilitary forces including Border Roads Organization. It was apparent that time that the MT malaria were chloroquin resistant and all cases reporting with fever (whether blood slide showed presence of malaria or otherwise) were treated with Inj quinine hydrochloride. The General Reserve Engineering Force personnel were not protected with suppressive treatment as possible with regular Army. Personal protection was given more importance and curative treatment with antimalarials was restricted only to cases showing presence of malaria parasites in peripheral blood. The mortality showed a definite reduction.
The second aspect is the use of suppressive treatment. Weekly intake of chloroquin may not be ideal as this gives a false sense of protection where individual soldiers compromise personal protection and nothing is more deplorable than their Commanders sharing the sense of protection.
Leaving aside the personal hazards ensuing from the compromise, the treatment of malaria in these protected group becomes vitiated and MT malaria presents in form of cerebral malaria with patient in coma. When the problem is of such a magnitude, cost effectiveness could be worked out and suppressive chemotherapy done away with all together. The observation made by Capt KM Hasssan pertaining to suppressive treatment (MJAFI Oct 94) does not appear to be acceptable. However, personal protection would be the sheet anchor in fight against mosquito borne diseases be it malaria, filaria or encephalitis.