Atovaquone/Proguanil Resistance in an Imported Malaria Case in Chile

Journal
The American Journal of Tropical Medicine and Hygiene
ISSN
0002-9637
1476-1645
Date Issued
2021
Author(s)
Stella M. Chenet
Alan Oyarce
Jorge Fernandez
Rafael Tapia-Limonchi
Juan R. Tejedo
Venkatachalam Udhayakumar
María Isabel Jercic
Naomi W. Lucchi
Type
Resource Types::text::journal::journal article
Scopus ID
2-s2.0-85105564911
WoS ID
WOS:000651201800043
DOI
URL
URL Institutional Repository
Abstract
<jats:title>ABSTRACT</jats:title><jats:p>In November 2018, we diagnosed a cluster of falciparum malaria cases in three Chilean travelers returning from Nigeria. Two patients were treated with sequential intravenous artesunate plus oral atovaquone/proguanil (AP) and one with oral AP. The third patient, a 23-year-old man, presented with fever on day 29 after oral AP treatment and was diagnosed with recrudescent falciparum malaria. The patient was then treated with oral mefloquine, followed by clinical recovery and resolution of parasitemia. Analysis of day 0 and follow-up blood samples, collected on days 9, 29, 34, 64, and 83, revealed that parasitemia had initially decreased but then increased on day 29. Sequencing confirmed Tyr268Cys mutation in the <jats:italic>cytochrome b</jats:italic> gene, associated with atovaquone resistance, in isolates collected on days 29 and 34 and <jats:italic>P. falciparum dihydrofolate reductase</jats:italic> mutation Asn51Ile, associated with proguanil resistance in all successfully sequenced samples. Molecular characterization of imported malaria contributes to clinical management in non-endemic countries, helps ascertain the appropriateness of antimalarial treatment policies, and contributes to the reporting of drug resistance patterns from endemic regions.</jats:p>
Cite this document
Chenet, S. M., Oyarce, A., Fernandez, J., Tapia-Limonchi, R., Weitzel, T., Tejedo, J. R., Udhayakumar, V., Jercic, M. I., & Lucchi, N. W. (2021). Atovaquone/proguanil resistance in an imported malaria case in chile. The American Journal of Tropical Medicine and Hygiene, 104(5), 1811-1813. https://doi.org/10.4269/ajtmh.20-1095
Subjects
plasmodium-falciparum

; 

cytochrome-b

; 

proguanil

; 

mutations

; 

adult

; 

antimalarials

; 

artesunate

; 

atovaquone

; 

chile

; 

cytochromes b

; 

drug combinations

; 

drug resistance

; 

female

; 

gene expression

; 

humans

; 

malaria, falciparum

; 

male

; 

mefloquine

; 

mutation

; 

nigeria

; 

parasitemia

; 

plasmodium falciparum

; 

proguanil

; 

protozoan proteins

; 

recurrence

; 

tetrahydrofolate dehydrogenase

; 

travel

; 

atovaquone plus proguanil

; 

cysteine

; 

dihydrofolate reductase

; 

mefloquine

; 

tyrosine

; 

antimalarial agent

; 

artesunate

; 

atovaquone

; 

atovaquone, proguanil drug combination

; 

cytochrome b

; 

dihydrofolate reductase

; 

mefloquine

; 

proguanil

; 

protozoal protein

; 

adult

; 

antimalarial drug resistance

; 

article

; 

blood sampling

; 

case report

; 

chile

; 

clinical article

; 

clinical feature

; 

convalescence

; 

fever

; 

follow up

; 

gene mutation

; 

gene sequence

; 

human

; 

malaria falciparum

; 

male

; 

young adult

; 

drug combination

; 

drug effect

; 

drug resistance

; 

female

; 

gene expression

; 

genetics

; 

growth, development and aging

; 

malaria falciparum

; 

mutation

; 

nigeria

; 

parasitemia

; 

parasitology

; 

pathogenicity

; 

pathology

; 

plasmodium falciparum

; 

recurrent disease

; 

travel