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Title: Recrudescence in artesunate-treated patients with falciparum malaria is dependent on parasite burden not on parasite factors
Authors: Wanida Ittarat
Amy L. Pickard
Panthip Rattanasinganchan
Polrat Wilairatana
Sornchai Looareesuwan
Kathryn Emery
Jonathan Low
Rachanee Udomsangpetch
Steven R. Meshnick
Mahidol University
The University of North Carolina at Chapel Hill
University of Michigan School of Public Health
Box 0944
Keywords: Immunology and Microbiology
Issue Date: 1-Feb-2003
Citation: American Journal of Tropical Medicine and Hygiene. Vol.68, No.2 (2003), 147-152
Abstract: Artemisinin derivatives are first-line antimalarial drugs in Thailand. No firm evidence of clinically relevant artemisinin resistance exists. When used as monotherapy, artesunate has been associated with a high treatment failure (recrudescence) rate, which could be due to low-level artemisinin resistance. To understand the causes of recrudescence, we retrospectively studied a cohort of 104 malaria patients treated with artesunate monotherapy, 32 of whom recrudesced. There was no difference in in vitro artesunate sensitivities between 6 nonrecrudescent isolates and 16 paired admission and recrudescent isolates. Paired admission and recrudescent isolates from 10 patients were genotyped; only 3 had pfmdr1 mutations. Patients with admission parasitemias >10,000 per μl had a 9-fold higher likelihood of recrudescence (adjusted odds ratio) compared with patients with lower parasitemias. This study suggests (1) recrudescence after treatment with artesunate is not the result of inherent parasite resistance, and (2) admission parasitemia may be useful in choosing therapeutic options.
ISSN: 00029637
Appears in Collections:Scopus 2001-2005

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