Atovaquone-proguanil resistance in imported falciparum malaria in a young child.
We discuss a case of atovaquone-proguanil treatment failure in a child from Mozambique, recently arrived in North America. Four weeks after completing therapy, symptomatic parasitemia recurred, caused by Plasmodium falciparum parasites bearing a Tyr268Ser mutation in cytochrome b. We review the literature concerning atovaquone-proguanil resistance, and emphasize the importance of follow-up and consideration of resistance where patients have relapsed symptoms.
Rose
Gregory W
GW
Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON, Canada. grrose@ottawahospital.on.ca
Suh
Kathryn N
KN
Kain
Kevin C
KC
Le Saux
Nicole
N
McCarthy
Anne E
AE
D000818:Animals; D000962:Antimalarials / Q000494:pharmacology* / Q000627:therapeutic use; D053626:Atovaquone / Q000494:pharmacology* / Q000627:therapeutic use; D002648:Child; D045304:Cytochromes c / Q000235:genetics; D004338:Drug Combinations; D004351:Drug Resistance / Q000235:genetics*; D006801:Humans; D016778:Malaria, Falciparum / Q000469:parasitology*; D008297:Male; D009073:Mozambique; D020125:Mutation, Missense; D009656:North America; D018512:Parasitemia; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000302:isolation & purification; D002727:Proguanil / Q000494:pharmacology* / Q000627:therapeutic use; D017211:Treatment Failure
D000962:Antimalarials; D004338:Drug Combinations; C109496:atovaquone, proguanil drug combination; D045304:Cytochromes c; D002727:Proguanil; D053626:Atovaquone