Abstract | BACKGROUND: CASE PRESENTATION: A 47-year-old female, native from Congo and resident in France, was admitted in hospital for uncomplicated falciparum malaria with parasitaemia of 0.5%, after travelling in Congo (Brazzaville and Pointe Noire). She was treated with atovaquone-proguanil (250 mg/100 mg) 4 tablets daily for 3 consecutive days. On day 5 after admission she was released home. However, many weeks after this episode, without having left France, she again experienced fever and intense weakness. On day 39 after the beginning of treatment, she consulted for fever, arthralgia, myalgia, photophobia, and blurred vision. She was hospitalized for uncomplicated falciparum malaria with a parasitaemia of 0.375% and treated effectively by piperaquine- artenimol (320 mg/40 mg) 3 tablets daily for 3 consecutive days. Resistance to atovaquone-proguanil was suspected. The Y268C mutation was detected in all of the isolates tested (D39, D42, D47). The genotyping of the pfdhfr gene showed a triple mutation (N51I, C59R, S108N) involved in cycloguanil resistance. CONCLUSION: This is the first observation of a late clinical failure of atovaquone-proguanil treatment of P. falciparum uncomplicated malaria associated with pfcytb 268 mutation in a traveller returning from Congo. These data confirm that the Y268C mutation is associated with delayed recrudescence 4 weeks or more after initial treatment. Although atovaquone-proguanil treatment failures remain rare, an increased surveillance is required. It is essential to declare and publish all well-documented cases of treatment failures because it is the only way to evaluate the level of resistance to atovaquone.
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Authors | Laurencie Massamba, Marylin Madamet, Nicolas Benoit, Alicia Chevalier, Isabelle Fonta, Véronique Mondain, Pierre-Yves Jeandel, Rémy Amalvict, Pascal Delaunay, Joel Mosnier, Pierre Marty, Christelle Pomares, Bruno Pradines |
Journal | Malaria journal
(Malar J)
Vol. 19
Issue 1
Pg. 37
(Jan 21 2020)
ISSN: 1475-2875 [Electronic] England |
PMID | 31964401
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antimalarials
- Artemisinins
- Artenimol-R
- Codon
- Drug Combinations
- Phenanthrenes
- Quinolines
- atovaquone, proguanil drug combination
- Cytochromes b
- piperaquine
- Tetrahydrofolate Dehydrogenase
- halofantrine
- Proguanil
- Atovaquone
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Topics |
- Antimalarials
(adverse effects, therapeutic use)
- Artemisinins
(administration & dosage)
- Atovaquone
(therapeutic use)
- Codon
(genetics)
- Congo
- Cytochromes b
(genetics)
- Drug Combinations
- Drug Resistance
(genetics)
- Female
- France
- Humans
- Malaria, Falciparum
(drug therapy, genetics)
- Middle Aged
- Mutation
- Phenanthrenes
(adverse effects, therapeutic use)
- Plasmodium falciparum
(drug effects, enzymology, genetics)
- Proguanil
(therapeutic use)
- Quinolines
(administration & dosage)
- Tetrahydrofolate Dehydrogenase
(genetics)
- Travel
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