Prophylaxis failure due to probable mefloquine resistant P falciparum from Tanzania.
Failures of mefloquine prophylaxis in travellers returning from Africa have been reported repeatedly. Non-compliance to chemoprophylaxis is considered to be a major factor for failure. Only few reports on mefloquine prophylaxis failure in sub-Saharan Africa were able to report blood levels of the drug that were sufficient for prophylactic effectiveness. We report the case of a 44-year-old German female who travelled to Tanzania for 3 weeks. The patient reported that she never missed a dose of mefloquine during her weekly prophylaxis schedule. Four weeks after returning from Tanzania, the patient presented with fever, headache and myalgia. Only a few trophozoites of Plasmodium falciparum were found in a thick film. Blood levels of mefloquine at that stage were at 1400 ng/ml, thus largely excluding non-compliance and malabsorption. To our knowledge, this is the first case of confirmed prophylaxis failure due to mefloquine resistance in East Africa.
Wichmann
O
O
Department of Infectious Diseases and Tropical Medicine, University of Munich, Leopoldstrasse 5, 80802 Munich, Germany.
Betschart
B
B
Löscher
T
T
Nothdurft
H D
HD
Sonnenburg
F V
FV
Jelinek
Tomas
T
D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000494:pharmacology*; D004351:Drug Resistance / Q000502:physiology; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000469:parasitology / Q000517:prevention & control*; D015767:Mefloquine / Q000494:pharmacology*; D018512:Parasitemia / Q000469:parasitology / Q000517:prevention & control; D010963:Plasmodium falciparum / Q000254:growth & development* / Q000378:metabolism; D013636:Tanzania; D014195:Travel
D000962:Antimalarials; D015767:Mefloquine