Severe atovaquone-resistant Plasmodium falciparum malaria in a Canadian traveller returned from the Indian subcontinent

We report the first case of atovaquone/proguanil treatment failure in severe Plasmodium falciparum malaria acquired by a non-immune traveller to the Indian subcontinent. Recrudescent infection was complicated by neurological involvement 14 days after directly observed therapy with atovaquone/proguan...

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Bibliographic Details
Published in:Open medicine 2009-01, Vol.3 (1), p.e10-e16
Main Authors: Perry, Thomas L, Pandey, Prativa, Grant, Jennifer M, Kain, Kevin C
Format: Article
Language:English
Subjects:
Plasmodium falciparum
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Summary:We report the first case of atovaquone/proguanil treatment failure in severe Plasmodium falciparum malaria acquired by a non-immune traveller to the Indian subcontinent. Recrudescent infection was complicated by neurological involvement 14 days after directly observed therapy with atovaquone/proguanil. Sequence analysis of the plasmodial cytochrome b gene confirmed a contribution of atovaquone resistance to treatment failure. The recrudescent isolate had a single mutation at position 268 (Tyr268Cys). Video recordings illustrate dramatic but ephemeral manifestations of malaria with neurological involvement.
ISSN:1911-2092