Imported quinine resistant Plasmodium falciparum malaria in Sri Lanka
Wijesundere, A.; Karunanayake, P.; Athukorala, I.; Jayasekara, K.
Ceylon Medical Journal 50(3): 125-126
2005
ISSN/ISBN: 0009-0875 PMID: 16252578 Document Number: 590639
In May 2003, a 52-year-old man from Ratnapura, Sri Lanka, employed as a gem cutter in Nigeria, developed high grade fever with chills, cough, vomiting and a confusional state. Based on blood film examinations, a diagnosis of Plasmodium falciparum malaria was made, and quinine infusion was immediately started at 20 mg/kg. However, he developed respiratory distress and became more drowsy, which necessitated an ICU admission in a tertiary referral hospital. Upon ICU admission, his Glasgow coma score was 4, and he was febrile, unconscious and jaundiced. His muscle tone was increased in all four limbs, with generalized hyperreflexia. A diagnosis of P. falciparum malaria complicated by cerebral malaria and multiorgan failure was made. Quinine infusion was continued, together with clarithromycin and ticarcillin-clavulanic acid. After 5 days of quinine therapy, he remained febrile and daily blood films remained positive for asexual stages of the parasite, indicating quinine resistance. Quinine was shifted to artemisinin and following artemisinin administration, his fever subsided and asexual parasitaemia disappeared. Clinical improvement followed.