Quinine-resistant severe falciparum malaria in north India: a documentation

Manish Chandey, Rahul Mannan, Tejinder Singh Bhasin, Mridu Manjari
2012 Indian Journal of Medical Specialities  
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/3.0) Conflict of interest: None declared | Source of funding: Nil | DOI: http://dx. Abstract Severe and complicated falciparum malaria carries a higher rate of morbidity and mortality in comparison to infection from other malarial species. A wide range of antimalarials are available which are therapeutically useful against Plasmodium falciparum (P. falciparum).
more » ... um (P. falciparum). Resistance of falciparum species against quinine has been reported from all parts of the world including India (North-east and South India). A 60 year old male presented with altered sensorium in emergency department of Sri Guru Ram Das Charitable Hospital, Amritsar, India which is a tertiary care centre in North Indian state of Punjab. Peripheral smears showed heavy parasitemia by crescent shaped gametocytes of P. falciparum. A provisional diagnosis of cerebral malaria was made and patient was started on parenteral quinine preparation (10 mg/kg thrice daily). However; patient's clinical condition did not improve and gametocytes of falciparum persisted in peripheral smear, even on the 5th day of therapy. Owing to apparent non-response to quinine therapy (noted both clinically and by laboratory investigations), he was switched to combination therapy of intravenous artesunate (2 mg/kg daily) plus clindamycin (10 mg/kg twice daily) on which he improved. The case is being reported as it documents presence of quinine resistance falciparum malaria in north India (Punjab), as previous all cases have been reported in north-east and south of country. It highlights the importance of using artemisinin in combination for proper eradication in case the patient is not responding to intravenous quinine.
doi:10.7713/ijms.2012.0063 fatcat:vlb37bk34bbv7ijc2jcolovbmm