title: Plasmodium vivax malaria in spite of atovaquone/proguanil (malarone) prophylaxis.
abstract: A 70-year-old male scientist, who had returned 5 weeks earlier from Ethiopia, was admitted to the hospital with symptoms consistent with malaria. On physical examination, he had orthostatic hypotension. He was dehydrated and showed a mild clinical delirium. Abdominal examination revealed a possible spleen tip, and he had petechial lesions bilaterally below his knees. Laboratory data revealed his white blood cell count to be 4,500/mL, with 67% polymorphonuclear cells and 15% band forms. The hemoglobin level was 13.9 g/dL, and the platelet count was low, at 32,000/mL.
authors.affiliation: Division of Communicable Disease, Wisconsin State Laboratory of Hygiene, Madison, WI, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Povinelli
authors.forename: Tim A
authors.initials: TA
authors.lastname: Monson
authors.forename: Barry C
authors.initials: BC
authors.lastname: Fox
authors.forename: Monica E
authors.initials: ME
authors.lastname: Parise
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Morrisey
authors.forename: Akhil B
authors.initials: AB
authors.lastname: Vaidya
mesh_terms: D000368:Aged; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D053626:Atovaquone; D045303:Cytochromes b / Q000235:genetics; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005002:Ethiopia; D006801:Humans; D016780:Malaria, Vivax / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D008297:Male; D009285:Naphthoquinones / Q000627:therapeutic use*; D010966:Plasmodium vivax / Q000235:genetics; D011110:Polymorphism, Genetic; D002727:Proguanil / Q000627:therapeutic use*; D017422:Sequence Analysis, DNA / Q000379:methods; D014195:Travel; D017211:Treatment Failure; D014481:United States
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D009285:Naphthoquinones; C109496:atovaquone, proguanil drug combination; D045303:Cytochromes b; D002727:Proguanil; D053626:Atovaquone