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Recurrent Plasmodium falciparum Malaria in U.S. Travelers Treated with Artemether–Lumefantrine

Hendrik Sy Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Sharan Yadav Division of Infectious Diseases, Weill Cornell Medicine, New York, New York;

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Peter Yangga Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Alexander Shaffer Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Amie John Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Wesley Rogers Division of Infectious Diseases, Weill Cornell Medicine, New York, New York;

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Lars Westblade Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York;

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Rebecca Marrero Rolón Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York;

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Susan Madison-Antenucci Parasitology Laboratory, New York State Department of Health, Albany, New York;

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Phyu M. Thwe Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Erika Orner Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Kerry Murphy Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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Grace A. Maldarelli Division of Infectious Diseases, Weill Cornell Medicine, New York, New York;

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Laura Kirkman Division of Infectious Diseases, Weill Cornell Medicine, New York, New York;
Department of Microbiology and Immunology, Weill Cornell Medicine, New York, New York

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Johanna P. Daily Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York;

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DOI:
https://doi.org/10.4269/ajtmh.24-0397
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Ahead of Print
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We report two cases of recurrent malaria in U.S. travelers returning from Africa (Ghana and Central African Republic) despite a full course of artemether–lumefantrine (AL). Both patients presented to New York City hospitals, received AL treatment, and clinically improved. Within 2 weeks, they presented with recurrent Plasmodium falciparum malaria. Parasite isolates were sequenced, and P. falciparum kelch 13 propeller domain mutations that are validated or candidate markers of artemisinin partial resistance were not identified. Parasites had mutations within the P. falciparum multidrug resistance protein 1 gene. It is crucial to remain vigilant for recurrent malaria in travelers, even from African regions where partial resistance to artemisinin-based combination therapy has only rarely been reported.

Author Notes

Financial support: The project described was supported by the National Center for Advancing Translational Sciences at NIH (Award No. UM1TR004400), the Geographic Medicine and Emerging Infections Training Program of the National Institute of Allergy and Infectious Diseases at NIH (Award No. 5T32AI070117), and the Global Health Equity Scholars Fellowship of the Launching Future Leaders in Global Health Research Training Program through Fogarty International Center at NIH (Award No. 5D43TW010540-08).

Disclosures: The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH.

Current contact information: Hendrik Sy, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, E-mail: hesy@montefiore.org. Sharan Yadav, Wesley Rogers, and Grace A. Maldarelli, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, E-mails: ssy9009@nyp.org, wer9011@nyp.org, and gam9044@med.cornell.edu. Peter Yangga, Alexander Shaffer, Amie John, Kerry Murphy, and Johanna P. Daily, Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, E-mails: pyangga@montefiore.org, ashaffer@montefiore.org, amjohn@montefiore.org, kerry.murphy@einsteinmed.edu, and jdaily@montefiore.org. Lars Westblade and Rebecca Marrero Rolón, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, E-mails: law9067@med.cornell.edu and rmarrerorolon@pennstatehealth.psu.edu. Susan Madison-Antenucci, Parasitology Laboratory, New York State Department of Health, Albany, New York, NY, E-mail: s.antenucci@health.ny.gov. Phyu M. Thwe and Erika Orner, Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, E-mails: pthwe@montefiore.org and eorner@montefiore.org. Laura Kirkman, Division of Infectious Diseases and Department of Microbiology and Immunology, Weill Cornell Medicine, New York, NY, E-mail: lak9015@med.cornell.edu.

Address correspondence to Hendrik Sy, Montefiore Medical Center, 3411 Wayne Ave., Bronx, NY 10467. E-mail: hesy@montefiore.org
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
15 Jun 2024
|
Accepted:
16 Oct 2024
|
Published Online:
07 Jan 2025
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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