TY - JOUR
T1 - Artemether-lumefantrine treatment failure of uncomplicated Plasmodium falciparum malaria in travellers coming from Angola and Mozambique
AU - Silva-Pinto, André
AU - Domingos, João
AU - Cardoso, Margarida
AU - Reis, Ana
AU - Benavente, Ernest Diez
AU - Caldas, João Paulo
AU - Conceição, Cláudia
AU - Toscano, Cristina
AU - Baptista-Fernandes, Teresa
AU - Clark, Taane G
AU - Mansinho, Kamal
AU - Campino, Susana
AU - Nogueira, Fatima
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Angola/epidemiology
KW - Antimalarials/therapeutic use
KW - Artemether, Lumefantrine Drug Combination/therapeutic use
KW - Artemether/therapeutic use
KW - Humans
KW - Malaria, Falciparum/drug therapy
KW - Male
KW - Middle Aged
KW - Mozambique/epidemiology
KW - Plasmodium falciparum/genetics
KW - Treatment Failure
U2 - 10.1016/j.ijid.2021.07.008
DO - 10.1016/j.ijid.2021.07.008
M3 - Article
C2 - 34242769
SN - 1201-9712
VL - 110
SP - 151
EP - 154
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -