Parasitology

A man aged in his 40s, recently returned from Uganda, was hospitalised with Plasmodium falciparum malaria, with hyperparasitaemia of ~1.5×106 parasites/μL (26%). He received intravenous artesunate followed by artemether–lumefantrine. However, parasite clearance was delayed, and despite a negative blood film following treatment, the patient was readmitted 3weeks later with recurrent parasitaemia. Further testing for drug-resistant phenotypes and genotypes demonstrated reduced susceptibility to lumefantrine, an A675V mutation in the pfk13 gene and increased ring-stage survival, consistent with partial artemisinin resistance. The case highlights the high risk of P. falciparum treatment failure in patients with hyperparasitaemia and partial drug resistance.

Jye Travis, Kate McCarthy, Paul Chapman, Lawrence Huang, Angelica Tan, Qin Cheng, Bridget E. Barber