title: Genetic confirmation of atovaquone-proguanil-resistant Plasmodium falciparum malaria acquired by a nonimmune traveler to East Africa.
abstract: We report a case of atovaquone-proguanil-resistant Plasmodium falciparum malaria acquired by a nonimmune traveler to Kenya. Recurrent parasitemia occurred 30 days after directly observed therapy with a combination of atovaquone and proguanil. Treatment failure was confirmed by genetic fingerprinting and sequencing. The primary isolate had wild-type sequence of cytochrome b; however, the recrudescent isolate had a single mutation at position 268 (Tyr268Ser).
authors.affiliation: Center for Geographic Medicine and Department of Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Eli
authors.initials: E
authors.lastname: Schwartz
authors.forename: Shay
authors.initials: S
authors.lastname: Bujanover
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kain
mesh_terms: D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone; D003573:Cytochrome b Group / Q000235:genetics / Q000378:metabolism; D004351:Drug Resistance / Q000235:genetics*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D009285:Naphthoquinones / Q000627:therapeutic use*; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000235:genetics; D002727:Proguanil / Q000627:therapeutic use*; D014195:Travel; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D003573:Cytochrome b Group; D009285:Naphthoquinones; D002727:Proguanil; D053626:Atovaquone