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Open Access Highly Accessed Case report

Artemether–lumefantrine treatment failure despite adequate lumefantrine day 7 concentration in a traveller with Plasmodium falciparum malaria after returning from Tanzania

Anna Färnert12*, Johan Ursing12, Thomas Tolfvenstam12, Josea Rono1, Lillemor Karlsson3, Elda Sparrelid2 and Niklas Lindegårdh45

Author Affiliations

1 Infectious Diseases Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden

2 Department of Infectious Diseases, Karolinska University Hospital, SE-171 76 Stockholm, Stockholm, Sweden

3 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden

4 Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

5 Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK

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Malaria Journal 2012, 11:176  doi:10.1186/1475-2875-11-176

Published: 25 May 2012

Abstract

Artemether-lumefantrine is currently first-line therapy of Plasmodium falciparum malaria in many countries. This report describes a treatment failure despite adequate drug concentrations in a traveller returning from sub-Saharan Africa. Genotyping confirmed recrudescence and suggested reduced sensitivity. Potential sub-optimal effect of artemether-lumefantrine highlights the need to follow non-immune individuals the weeks after treatment.

Keywords:
Malaria; P. falciparum; Artemisinin; Lumefantrine; Sensitivity; non-immune