title: Quinine-resistant severe falciparum malaria effectively treated with atovaquone and proguanil hydrochloride combination therapy.
abstract: A 22-year-old Japanese man noticed pyrexia and diarrhea after travel to Guinea. Notable physical findings included hepatosplenomegaly. Treatment with oral quinine and minocycline was started after definitive diagnosis of falciparum malaria by blood smear. Initially, parasitemia and body temperature decreased but by the third night of therapy his temperature increased to 40 degrees C with a slight increase of parasite count. When quinine treatment was changed to atovaquone/proguanil, his temperature dropped immediately and complete plasmodial elimination was confirmed on microscopic examination. Subsequent recrudescence of the disease was not observed. It was concluded that the antimalarial treatment with atovaquone/proguanil might become invaluable in Japan.
authors.affiliation: Department of Medicine, Nantan General Hospital, Funai-gun, Kyoto.
authors.forename: Hitoji
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Akio
authors.initials: A
authors.lastname: Okamoto
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Sato
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yamada
authors.forename: Sadatsugu
authors.initials: S
authors.lastname: Murakami
authors.forename: Seiichi
authors.initials: S
authors.lastname: Yoneda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kajita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tegoshi
authors.forename: Naoki
authors.initials: N
authors.lastname: Arizono
mesh_terms: D000328:Adult; D053626:Atovaquone; D001774:Blood Chemical Analysis; D001854:Bone Marrow Cells / Q000166:cytology / Q000469:parasitology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D009285:Naphthoquinones / Q000008:administration & dosage*; D002727:Proguanil / Q000008:administration & dosage*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009285:Naphthoquinones; D002727:Proguanil; D053626:Atovaquone