Volume 72, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The importation of drug-resistant malaria is a growing public health problem in non-endemic countries. The combination of atovaquone and proguanil (Malarone™) has become established as an agent of choice to prevent and treat chloroquine-resistant malaria in travelers. We describe the first reported case in North America of genetically confirmed atovaquone/proguanil-resistant 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.


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  • Received : 07 May 2004
  • Accepted : 17 Sep 2004

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