Genomic characterization of recrudescent plasmodium malariae after treatment with artemether/lumefantrine

Gavin G. Rutledge, Ian Marr, G. Khai Lin Huang, Sarah Auburn, Jutta Marfurt, Mandy Sanders, Nicholas J. White, Matthew Berriman, Chris I. Newbold, Nicholas M. Anstey, Thomas D. Otto, Ric N. Price

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    Abstract

    Plasmodium malariae is the only human malaria parasite species with a 72-hour intraerythrocytic cycle and the ability to persist in the host for life. We present a case of a P. malariae infection with clinical recrudescence after directly observed administration of artemether/lumefantrine. By using whole-genome sequencing, we show that the initial infection was polyclonal and the recrudescent isolate was a single clone present at low density in the initial infection. Haplotypic analysis of the clones in the initial infection revealed that they were all closely related and were presumably recombinant progeny originating from the same infective mosquito bite. We review possible explanations for the P. malariae treatment failure and conclude that a 3-day artemether/lumefantrine regimen is suboptimal for this species because of its long asexual life cycle.

    Original languageEnglish
    Pages (from-to)1300-1307
    Number of pages8
    JournalEmerging Infectious Diseases
    Volume23
    Issue number8
    DOIs
    Publication statusPublished - 1 Aug 2017

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