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Am. J. Trop. Med. Hyg., 72(4), 2005, pp. 407-409
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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EMERGENCE OF ATOVAQUONE-PROGUANIL RESISTANCE DURING TREATMENT OF PLASMODIUM FALCIPARUM MALARIA ACQUIRED BY A NON-IMMUNE NORTH AMERICAN TRAVELLER TO WEST AFRICA

SUSAN KUHN, M. JOHN GILL, AND KEVIN C. KAIN
Department of Pediatrics, Medicine, Medical Microbiology & Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; McLaughlin-Rotman Global Health Program, McLaughlin Center for Molecular Medicine, University of Toronto; Toronto, Ontario, Canada; Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada

The importation of drug-resistant malaria is a growing public health problem in non-endemic countries. The combination of atovaquone and proguanil (MalaroneTM) has become established as an agent of choice to prevent and treat chloroquine-resistant Plasmodium falciparum malaria in travelers. We describe the first reported case in North America of genetically confirmed atovaquone/proguanil-resistant P. falciparum malaria. Polymerase chain reaction and sequence analysis of the primary and recrudescent isolates confirmed the acquisition of a point mutation (Tyr268Ser) in the cytochrome b gene of the recrudescent isolate known to confer high-level resistance to atovaquone. Suboptimal therapy may have played a contributory role in the emergence of resistance.

Received May 7, 2004. Accepted for publication September 17, 2004.

Financial support: This work was supported by the Canadian Institutes of Health Research (CIHR, MT-13721). Kevin C. Kain is supported by a Career Scientist Award from the Ontario Ministry of Health and a Canada Research Chair (CIHR).

Disclosure: Susan Kuhn is on the speaker’s bureau for GlaxoSmith-Kine, which produces MalaroneTM. This statement is made in the interest of full disclosure, and not because the author considers this a conflict of interest.

Authors’ addresses: Susan Kuhn and M. John Gill, Department of Pediatrics, Medicine, Medical Microbiology & Infectious Diseases, University of Calgary, Calgary T2N 1N4, Alberta, Canada. Kevin C. Kain, Toronto General Hospital, 200 Elizabeth Street, ES 9-412, Toronto M5G 2C4, Ontario, Canada, Telephone: 416-340-3535, Fax: 416-595-5826, E-mail: Kevin.Kain{at}uhn.on.ca.




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