title: Severe unresolvingPlasmodium falciparummalaria following artemisinin combination therapy: Emergence of drug resistance in Saudi Arabia.
abstract: A 5-year-old female child presented with fever of 1-week duration after visiting a malaria endemic zone without antimalarial prophylaxis. The patient presented with respiratory distress, decreased level of consciousness and high-grade fever. An elevated parasitaemia reaching 800,000/μl was observed. Antimalarial therapy was initiated with artesunate being administered intravenous (IV) along with IV clindamycin. Contrary to the expectations, there was no resolution of fever. Following a week of unresolved fever, the drug therapy was revised and altered to IV quinine dihydrochloride and IV clindamycin. Emergence of non-responsiveness to artesunate in Saudi Arabia is an alarming sign and requires revision of management protocols.
authors.affiliation: Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: I A
authors.initials: IA
authors.lastname: Al-Zaydani
authors.affiliation: Department of Microbiology, College Of Medicine, King Khalid University, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Al-Hakami
authors.affiliation: Department of Microbiology, College Of Medicine, King Khalid University, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Microbiology, College Of Medicine, King Khalid University, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: S A
authors.initials: SA
authors.lastname: Abdalla
authors.affiliation: Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Otaif
authors.affiliation: Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: Rma
authors.initials: R
authors.lastname: Thiqa
authors.affiliation: Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
authors.forename: K
authors.initials: K
authors.lastname: Alnahili
mesh_terms: D061605:Administration, Intravenous; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000188:drug therapy*; D011803:Quinine / Q000627:therapeutic use; D012529:Saudi Arabia; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D002981:Clindamycin; D000077332:Artesunate; D011803:Quinine