An intricate case of multidrug resistant Plasmodium falciparum isolate imported from Cambodia

• Published in: Malaria journal Vol. 16; no. 1; p. 149
• Main Authors: Dell'Acqua, Raffaele, Fabrizio, Claudia, Di Gennaro, Francesco, Lo Caputo, Sergio, Saracino, Annalisa, Menegon, Michela, L'Episcopia, Mariangela, Severini, Carlo, Monno, Laura, Castelli, Francesco, Angarano, Gioacchino
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14-04-2017; BioMed Central; BMC
• Subjects: Adult; Anemia; Antimalarials; Artemisinin; Artemisinins - pharmacology; Artemisinins - therapeutic use; Atovaquone; Atovaquone - therapeutic use; Blood transfusions; Cambodia; Case Report; Coinfection - diagnosis; Coinfection - parasitology; Drug Combinations; Drug dosages; Drug resistance; Drug Resistance, Multiple; Erythrocytes; Failure; Fever; Genes; Hemoglobin; Hospitals; Human diseases; Humans; Intravenous administration; Lactones - pharmacology; Lactones - therapeutic use; Malaria; Malaria - diagnosis; Malaria - parasitology; Malaria, Falciparum; Malaria, Vivax; Male; Multidrug resistance; Multidrug resistant organisms; Multiple; Mutation; Plasmodium falciparum; Plasmodium falciparum - drug effects; Plasmodium falciparum - isolation & purification; Plasmodium vivax - drug effects; Plasmodium vivax - isolation & purification; Proguanil; Proguanil - therapeutic use; Quinine; Quinine - pharmacology; Quinine - therapeutic use; Travel; Treatment Outcome; Vector-borne diseases; Cambodia; Malaria, Falciparum; Malaria, Vivax; Multiple; Cambodia; Genes, MDR; Malaria; Antimalarials; Drug resistance; Travel medicine
• ISSN: 1475-2875; 1475-2875
• DOI: 10.1186/s12936-017-1795-y

Imported cases of multidrug resistant Plasmodium falciparum and treatment failure with artemisinin-based regimens, although rare, have been described also in Western countries and their management is often challenging. This is also due to an inadequate knowledge and implementation of health prevention measures.
A complex case of imported malaria caused by Plasmodium vivax/P. falciparum isolates in a patient who was not taking chemoprophylaxis while he was travelling in Cambodia is reported in this article. After failures of artemisinin-based and both oral and intravenous quinine-based regimens, a multidrug resistant P. falciparum was detected. The patient was successfully treated with atovaquone-proguanil.
This experience highlights the importance of a careful management that should be based not only on the most up-to-date guidelines, but also on the awareness of a rapidly evolving scenario.