Malarone treatment failure and in vitro confirmation of resistance of Plasmodium falciparum isolate from Lagos, Nigeria

Quinton L Fivelman¹ , Geoffrey A Butcher² , Ipemida S Adagu¹ , David C Warhurst¹ and Geoffrey Pasvol³

¹Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

²Department of Biology, Sir Alexander Fleming Building, Impeial College, Imperial College Road, London, SW7 2AZ, UK

³Department of Infection and Tropical Medicine, Faculty of Medicine, Imperial College, Lister Unit, Northwick Park Hospital, Harrow, Middlesex, HA1 3UJ, UK

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Malaria Journal 2002, 1:1doi:10.1186/1475-2875-1-1


Published:	8 February 2002

Abstract

We report the first in vitro and genetic confirmation of Malarone^® (GlaxoSmithKline; atovaquone and proguanil hydrochloride) resistance in Plasmodium falciparum acquired in Africa. On presenting with malaria two weeks after returning from a 4-week visit to Lagos, Nigeria without prophylaxis, a male patient was given a standard 3-day treatment course of Malarone^®. Twenty-eight days later the parasitaemia recrudesced. Parasites were cultured from the blood and the isolate (NGATV01) was shown to be resistant to atovaquone and the antifolate pyrimethamine. The cytochrome b gene of isolate NGATV01 showed a single mutation, Tyr268Asn which has not been seen previously.