Multidrug-resistant malaria from South Africa [letter]

A 28-year-old white woman who had not previously travelled to an area where malaria is endemic spent 2 weeks on holiday in Zimbabwe Botswana and South Africa. She took regular antimalarial prophylaxis with weekly dosages of chloroquine (300 mg) and daily dosages of proguanil (200 mg). The patient remained healthy while she was away. Four days after returning to London she developed headache generalized musculoskeletal pain and an intermittent fever. Three days later she presented to our hospital (Hospital for Tropical Diseases London United Kingdom) with a fever (temperature 40_C) and sinus tachycardia (heart rate 120 beats/min). There were no localized signs of infection. A blood film confirmed the diagnosis of Plasmodium falciparum malaria and peripheral-blood parasitemia (parasite percentage 0.1%). The patient was treated with 9 oral doses of quinine at dosages of 600 mg t.i.d. which cleared the parasitemia; she then received a single dose of 3 tablets of sulfadoxine-pyrimethamine according to standard practice at the hospital and was discharged. (excerpt)