Emergence of atovaquone-proguanil resistance during treatment of Plasmodium falciparum malaria acquired by a non-immune north American traveller to west Africa.

Abstract

The importation of drug-resistant malaria is a growing public health problem in non-endemic countries. The combination of atovaquone and proguanil (Malarone) has become established as an agent of choice to prevent and treat chloroquine-resistant Plasmodium falciparum malaria in travelers. We describe the first reported case in North America of genetically confirmed atovaquone/proguanil-resistant P. falciparum malaria. Polymerase chain reaction and sequence analysis of the primary and recrudescent isolates confirmed the acquisition of a point mutation (Tyr268Ser) in the cytochrome b gene of the recrudescent isolate known to confer high-level resistance to atovaquone. Suboptimal therapy may have played a contributory role in the emergence of resistance.

• Authors: Susan Kuhn, M John Gill, Kevin C Kain
• Journal: The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 72 Issue 4 Pg. 407-9 (Apr 2005) ISSN: 0002-9637 [Print] United States
• PMID: 15827276 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Naphthoquinones
• Cytochromes b
• Proguanil
• Atovaquone

Topics

• Adult
• Animals
• Antimalarials (administration & dosage, therapeutic use)
• Atovaquone
• Canada (ethnology)
• Cytochromes b (genetics)
• Drug Resistance
• Female
• Humans
• Malaria, Falciparum (drug therapy)
• Naphthoquinones (administration & dosage, therapeutic use)
• Plasmodium falciparum (enzymology)
• Proguanil (administration & dosage, therapeutic use)
• Sierra Leone