J Korean Med Sci.  2024 Jun;39(22):e186. 10.3346/jkms.2024.39.e186.

Late Parasitological Failure and Subsequent Isolated Gametocytemia of Uncomplicated Plasmodium falciparum Malaria in a Returned Traveler From Ghana, 2023

• Bae J
• Kim JH
• Kim S
• Huh J
• Choi HJ

• KMID: 2556300
• DOI: http://doi.org/10.3346/jkms.2024.39.e186

Abstract

Herein, we report a case of uncomplicated falciparum malaria with late parasitological failure in a 45-year-old businessman returning from Ghana. The patient visited the emergency department with high fever, headache, and dizziness. He traveled without antimalarial chemoprophylaxis. Laboratory tests led to the diagnosis of uncomplicated falciparum malaria with an initial density of 37,669 parasites per μL of blood (p/μL). The patient was treated with intravenous artesunate followed by atovaquone/proguanil. He was discharged with improved condition and decreased parasite density of 887 p/μL. However, at follow-up, parasite density increased to 7,630 p/μL despite the absence of any symptoms. Suspecting treatment failure, the patient was administered intravenous artesunate and doxycycline for seven days and then artemether/lumefantrine for three days. Blood smear was negative for asexual parasitemia after re-treatment but positive for gametocytemia until day 101 from the initial diagnosis. Overall, this case highlights the risk of late parasitological failure in patients with imported uncomplicated falciparum malaria.

Keyword

Plasmodium falciparum; Malaria; Treatment Failure; Parasitemia; Gametocytemia

Figure

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  Fig. 1 Peripheral blood smear of the patient. Parasite density significantly decreased from (A) to (B) after the administration of antimalarial treatment, followed by a resurgence on day 8 after the completion of first treatment. Upon second admission, parasite density increased to 7,630 parasites per μL (C). Infected red blood cells with ring forms, trophozoites, and schizonts were detected during the second treatment. Only gametocytemia was observed at the second discharge (figure not shown). Parasite densities on (A) day 1 of admission, (B) day 7 of admission, and (C) day 2 of re-admission (day 31 from diagnosis).

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