SHM Converge Scientific Abstract ePoster Gallery-Malaria Treatment Failure: Isolated Event or Emerging Trend?

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This case describes a 51-year-old man with poorly controlled diabetes who returned from Nigeria and presented with fever, abdominal symptoms, diabetic ketoacidosis, thrombocytopenia, anemia, and elevated liver enzymes. Testing confirmed Plasmodium falciparum malaria with 5% parasitemia. He was treated with artemether-lumefantrine and initially improved, with parasitemia falling to 0.1% at discharge. However, he was readmitted two weeks later with recurrent fever and severe anemia, and repeat smear showed rising parasitemia to 2.4%, consistent with malaria recrudescence. Because of concern for possible artemisinin resistance, he was switched to atovaquone-proguanil and recovered fully.<br /><br />The report emphasizes that malaria remains a major global health problem, especially in Nigeria, where Plasmodium falciparum is the dominant species and artemisinin-based combination therapy is the standard first-line treatment. Although clear ACT resistance has not yet been widely reported in Nigeria, there is growing concern about emerging resistance based on surveillance data from other parts of Africa and molecular marker monitoring programs. The authors stress the importance of recognizing treatment failure in returning travelers, especially when symptoms recur after standard therapy.<br /><br />The discussion highlights the need for clinicians to stay informed about evolving malaria resistance patterns, monitor for recrudescence, and consider alternative therapies early when initial treatment does not fully succeed. Rapid sharing of resistance surveillance data is essential to guide treatment decisions and prevent delayed recognition of resistant malaria.

Asset Subtitle

Radhika A. Patel

Meta Tag

Author List Folasade Arinze, Radhika A. Patel

Category Clinical Vignettes

Concept Malaria Treatment Failure

Concept Malaria Recrudescence

Concept Severe Malaria

Concept Plasmodium falciparum

Concept Artemisinin-Based Combination Therapy

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital GME Internal Medicine Residency Program

Presenting Author Radhika A. Patel

Track Adult

Keywords

Plasmodium falciparum

malaria recrudescence

artemisinin resistance

Nigeria

diabetic ketoacidosis

thrombocytopenia

anemia

artemether-lumefantrine

atovaquone-proguanil

returning traveler

Malaria Treatment Failure

Malaria Recrudescence

Severe Malaria

Plasmodium falciparum

Artemisinin-Based Combination Therapy