Chloroquine‐ResistantPlasmodium falciparumCerebral Malaria in a Chloroquine‐Susceptible Area

Abstract

Chloroquine-resistant Plasmodium falciparum is endemic in many areas. Saudi Arabia was considered to have chloroquine-susceptible P. falciparum. During the 1997-1998 season, an outbreak of malaria occurred in the southwestern region. Over a 4-month period, 32 cases (6.2%) of 520 malaria admissions met the World Health Organization criteria for cerebral malaria. The mean patient age was 28 years. Thirteen male and 19 female patients were admitted in coma. The mean duration of coma was 4.3 days; the case fatality rate was 41%. Compared with those who recovered, patients who died had a lower mean admission diastolic blood pressure and hemoglobin level, higher mean blood urea nitrogen and blood glucose levels, and thrombocytopenia. Logistic regression analysis identified treatment with quinine rather than chloroquine to be associated with survival. These findings show the potential of P. falciparum to emerge as chloroquine resistant in previously susceptible areas, resulting in significant morbidity and mortality in spite of sophisticated medical care.

Distribution of Drug Resistance Genotypes in Plasmodium falciparum in an Area of Limited Parasite Diversity in Saudi Arabia

“…Malaria transmission occurs after the rainy season from November to March and the appearance of Anopheles mosquitoes. P. falciparum in the region was at one time susceptible to chloroquine; however, resistance emerged in the late 1990s, 14 and mutations associated with CQR have escalated in the region. 9 This finding prompted the change of treatment policy to artemisinin-based combination therapies (ACTs).…”

“…1,12 Chloroquine was the drug of choice for the treatment of uncomplicated malaria cases for many years. However, the emergence and spread of chloroquine resistance (CQR) [13][14][15] has lead to the introduction of sulfadoxine-pyrimethamine (SP) therapy, which is effective. Nonetheless, recently health authority in Saudi Arabia has adopted artemisinin combination therapy (ACT), consisting of artemisinin plus SP.…”

Malaria and hypertension. Another co-evolutionary adaptation?

“…Nonimmune malaria patients, such as travelers, are more susceptible to succumb to CM and develop neurological sequelae (Alrajhi et al, 1999; Roze et al, 2001). But not all nonimmune travelers have the same odds to develop malaria complications.…”

Analysis of gene mutations involved in chloroquine resistance inPlasmodium falciparumparasites isolated from patients in the southwest of Saudi Arabia

“…In Saudi Arabia, the strategy to treat malaria cases was changed in 2008 by the Saudi health authorities with the introduction of artemisinin combination therapy (ACT) that consists of SP and artemisinin 13. Saudi Arabia is one of the few areas where P falciparum remained sensitive to chloroquine until the early 1990s despite the fact that CQR emerged in malaria-endemic countries close to Saudi Arabia, such as Iran, Pakistan, and East Africa where CQR was first reported in the early 1980s 1415. A recent study examined a limited number of samples from the Jazan region for P falciparum chloroquine-resistant transporter (PfCRT) gene and found a CQR rate of 89.5% 16…”