title: [The management of therapeutic failure in a falciparum malaria patient under oral arthemether-lumefantrine therapy].
abstract: Malaria is a parasitic infection characterized by anemia, splenomegaly and periodic fever. This infection has a tendency to cause serious complications. Falciparum malaria could occur in our country as an imported case due to increasing intercontinental travel opportunities. The World Health Organisation (WHO) recommends arthemether combination treatment as a first line choice. Here we report a Turkish case admitted to the hospital with high fever, sweating and fatigue. He had been in Uganda for 6 months without prophylaxis. Plasmodium falciparum with an intense parasitic load was diagnosed. We started arthemether-lumefantrine combination therapy immediately. 18 days after his discharge he was readmitted with the same complaints and parasitemia was detected once again. This time, we treated him with the quinine-tetracycline combination regime for 7 days. Within 48 hours the patient was afebrile and the blood smear was negative. Falciparum malaria must be considered in infection emergencies for febrile patients especially with any travel history. For an initial therapy, arthemetherlumefantrine combination is a successful choice of treatment. Even with adequate treatment of arthemether-lumefantrine combination, the problems of recurrence (recrudescence or reinfection) could occur due to treatment failure. For the possibility of recurrence, close monitoring of patients is very important in the critical course after adequate treatment.
authors.affiliation: Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Servisi, İstanbul, Türkiye.
authors.forename: Asım
authors.initials: A
authors.lastname: Ülçay
authors.forename: Gökhan
authors.initials: G
authors.lastname: Karaahmetoğlu
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
authors.forename: Hakan
authors.initials: H
authors.lastname: Erdem
authors.forename: Ali
authors.initials: A
authors.lastname: Acar
authors.forename: Oral
authors.initials: O
authors.lastname: Öncül
authors.forename: Levent
authors.initials: L
authors.lastname: Görenek
mesh_terms: D000284:Administration, Oral; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D005449:Fluorenes / Q000627:therapeutic use*; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000187:drug effects / Q000502:physiology; D011803:Quinine / Q000627:therapeutic use*; D012008:Recurrence; D013752:Tetracycline / Q000627:therapeutic use*; D014195:Travel; D017211:Treatment Failure; D014421:Turkey; D014454:Uganda
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011803:Quinine; D013752:Tetracycline