AN UNUSUAL MALARIA CASE: MIXED INFECTION? RESISTANCE? MALADAPTIVE PATIENT?

Abstract

Malaria, a disease known since ancient times and constantly struggled by human beings, still maintains its currency as an important cause of morbidity and mortality today. Although no domestic cases have been observed in Turkey since 2010, around 200-250 malaria cases originating from abroad are observed every year. Resistance to many parasitic drugs has developed over the years since chloroquine resistance emerged in the 1970s. Artemisinin resistance was reported by WHO in Cambodia, Laos, Myanmar, Thailand and Vietnam in 2013 due to P. falciparum malaria, and resistance has been reported also in South Africa and Rwanda recently. It has been shown that resistance development is due to the Kelch 13 mutation detected in parasite and this leads to delayed clearance. According to WHO data, artemether-based combined therapy is still effective in the treatment of patients infected with artemisinin-resistant P. falciparum strains, but possible treatment unresponsiveness is followed meticulously by WHO. Our case is remarkable for its third recurrence despite artemether-based combined therapy twice in 28 days, and its persistent treatment response after quinine and doxycycline treatment.