Artemether-lumefantrine treatment failure of uncomplicated Plasmodium falciparum malaria in travellers coming from Angola and Mozambique

André Silva-Pinto, João Domingos, Margarida Cardoso, Ana Reis, Ernest Diez Benavente, João Paulo Caldas, Cláudia Conceição, Cristina Toscano, Teresa Baptista-Fernandes, Taane G Clark, Kamal Mansinho, Susana Campino, Fatima Nogueira

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The failure of artemisinin combination therapy (ACT) in malaria patients returning from endemic regions may be driven by parasite resistance to this treatment. ACT is used globally as the first-line treatment for Plasmodium falciparum malaria. However, artemisinin-resistant strains of P. falciparum have emerged and spread across Southeast Asia, with the risk of reaching high malaria burden regions in Africa and elsewhere. Here, we report on two malaria imported cases from Africa with possible parasite resistance to the ACT artemether-lumefantrine (AL). Case presentation: Two middle-aged males returning from Angola and Mozambique developed malaria symptoms in Portugal, where they were diagnosed and received treatment with AL as hospital inpatients. After apparent cure and discharge from hospital, these individuals returned to hospital showing signs of late clinical failure. Molecular analysis was performed across a number of drug resistance associated genes. No evidence of pfk13-mediated artemisinin resistance was found. Both subjects had complete parasite clearance after treatment with non-ACT antimalarials. Conclusion: Our case-studies highlights the need for close monitoring of signs of unsatisfactory antimalarial efficacy among AL treated patients and the possible implication of other genes or mutations in the parasite response to ACTs.

Original languageEnglish
Pages (from-to)151-154
Number of pages4
JournalInternational Journal of Infectious Diseases
Volume110
DOIs
Publication statusPublished - Sept 2021
Externally publishedYes

Keywords

  • Angola/epidemiology
  • Antimalarials/therapeutic use
  • Artemether, Lumefantrine Drug Combination/therapeutic use
  • Artemether/therapeutic use
  • Humans
  • Malaria, Falciparum/drug therapy
  • Male
  • Middle Aged
  • Mozambique/epidemiology
  • Plasmodium falciparum/genetics
  • Treatment Failure

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