Failure of dihydroartemisinin-piperaquine treatment of uncomplicated Plasmodium falciparum malaria in a traveller coming from Ethiopia.
BACKGROUND
Artemisinin combination therapy (ACT) is used worldwide as the first-line treatment against uncomplicated Plasmodium falciparum malaria. Despite the success of ACT in reducing the global burden of malaria, the emerging of resistance to artemisinin threatens its use.


METHODS
This report describes the first case of failure of dihydroartemisinin-piperaquine (DHA-PPQ) for the treatment of P. falciparum malaria diagnosed in Europe. It occurred in an Italian tourist returned from Ethiopia. She completely recovered after the DHA-PPQ treatment but 32 days after the end of therapy she had a recrudescence. The retrospective analysis indicated a correct DHA-PPQ absorption and genotyping demonstrated that the same P. falciparum strain was responsible for the both episodes.


CONCLUSIONS
In consideration of the growing number of cases of resistance to ACT, it is important to consider a possible recrudescence, that can manifest also several weeks after treatment.
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy. federico.gobbi@sacrocuore.it.
Federico
F
Gobbi
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy.
Dora
D
Buonfrate
Department of Infectious, Parasitic and Immunomediated Diseases (MIPI), Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
Michela
M
Menegon
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy.
Gianluigi
G
Lunardi
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy.
Andrea
A
Angheben
Department of Infectious, Parasitic and Immunomediated Diseases (MIPI), Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
Carlo
C
Severini
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy.
Stefania
S
Gori
Centre for Tropical Diseases, Hospital Sacro Cuore-Don Calabria, Via Sempreboni 5, Negrar, 37024, Verona, Italy.
Zeno
Z
Bisoffi
D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D005002:Ethiopia; D005602:France; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy*; D008889:Military Personnel; D050177:Overweight / Q000150:complications*; D011804:Quinolines / Q000008:administration & dosage*; D017211:Treatment Failure; D010879:Piperazines
D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
Dihydroartemisinin-piperaquine (DHA-PPQ); Failure; Plasmodium falciparum; Recrudescence