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- Title
Genomic Characterization of Recrudescent Plasmodium malariae after Treatment with Artemether/Lumefantrine.
- Authors
Rutledge, Gavin G.; Marr, Ian; Khai Lin Huang, G.; Auburn, Sarah; Marfurt, Jutta; Sanders, Mandy; White, Nicholas J.; Berriman, Matthew; Newbold, Chris I.; Anstey, Nicholas M.; Otto, Thomas D.; Price, Ric N.; Huang, G Khai Lin
- Abstract
Plasmodium malariae is the only human malaria parasite species with a 72-hour intraerythrocytic cycle and the ability to persist in the host for life. We present a case of a P. malariae infection with clinical recrudescence after directly observed administration of artemether/lumefantrine. By using whole-genome sequencing, we show that the initial infection was polyclonal and the recrudescent isolate was a single clone present at low density in the initial infection. Haplotypic analysis of the clones in the initial infection revealed that they were all closely related and were presumably recombinant progeny originating from the same infective mosquito bite. We review possible explanations for the P. malariae treatment failure and conclude that a 3-day artemether/lumefantrine regimen is suboptimal for this species because of its long asexual life cycle.
- Subjects
GENOME mapping of plasmodium; MALARIA treatment; PARASITE life cycles; DISEASE relapse; MOSQUITO vectors; ARTEMISININ; PLASMODIUM genetics; THERAPEUTICS; HYDROCARBONS; DRUG therapy for malaria; PRIMAQUINE; CHLOROQUINE; ANTIMALARIALS; ETHANOLAMINES; COMBINATION drug therapy; COMPARATIVE studies; DRUG resistance; MALARIA; RESEARCH methodology; MEDICAL cooperation; PROTOZOA; RESEARCH; RESEARCH funding; EVALUATION research
- Publication
Emerging Infectious Diseases, 2017, Vol 23, Issue 8, p1300
- ISSN
1080-6040
- Publication type
journal article
- DOI
10.3201/eid2308.161582