DYNAMICS OF PLASMODIUM FALCIPARUM MALARIA AFTER SUB-OPTIMAL THERAPY IN UGANDA

ALISSA MYRICK Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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ERIKA LEEMANN Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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CHRIS DOKOMAJILAR Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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HEIDI HOPKINS Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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GRANT DORSEY Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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MOSES R. KAMYA Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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PHILIP J. ROSENTHAL Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Makerere University, Kampala, Uganda

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We followed parasite genotypes of 75 patients for 42 days after treatment of uncomplicated malaria with chloroquine + sulfadoxine-pyrimethamine in Kampala, Uganda. Infections were complex (mean, 2.88 strains) and followed three patterns: 27% of patients eliminated all strains and remained parasite-free, 48% had a long aparasitemic interval followed by reappearance of original strains after 3–33 days (mean, 9.2 days), and 25% failed to clear original strains and required therapy after 3–35 days (mean, 17 days). These results highlight the complexity of malaria in Africa and have implications for efficacy trials, because missing late reappearances of strains could lead to misclassification of outcomes.

Author Notes

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