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Chloroquine Resistant Vivax Malaria in a Pregnant Woman on the Western Border of Thailand

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Case Reports

Chloroquine Resistant Vivax Malaria in a Pregnant Woman on the Western Border of Thailand

Marcus J Rijken et al. Malar J.

Abstract

Chloroquine (CQ) resistant vivax malaria is spreading. In this case, Plasmodium vivax infections during pregnancy and in the postpartum period were not satisfactorily cleared by CQ, despite adequate drug concentrations. A growth restricted infant was delivered. Poor susceptibility to CQ was confirmed in-vitro and molecular genotyping was strongly suggestive of true recrudescence of P. vivax. This is the first clinically and laboratory confirmed case of two high-grade CQ resistant vivax parasite strains from Thailand.

Figures

Figure 1
Figure 1
Plasmodium vivax infections in a Karen woman observed over 227 days pregnancy and postpartum period. The P. vivax genotypes (indicated by bars of different colours) are based on polymorphisms in 4 genes (Pvcs, Pvmsp1, Pvmsp3-α, and Pvmdr1). The treatments administered are indicated on top. PCR spots are indicated with black (negative) and grey (positive) dots. The intrinsic sensitivity profile of P. vivax isolate to a range of standard antimalarials (chloroquine (QC), artesunate (AS), piperaquine (PPQ), mefloquine (MQ) and amodiaquine (AMQ)) is shown for the parasites collected on D31. The in vivo serum concentrations of CQ + desethylchloroquine (DECQ) are indicated for the samples collected on D31, D71 and D143.

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