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Indian J Med Microbiol. 2016 Oct-Dec;34(4):553-557. doi: 10.4103/0255-0857.195352.

Severe unresolving Plasmodium falciparum malaria following artemisinin combination therapy: Emergence of drug resistance in Saudi Arabia.

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Department of Paediatric, Aseer Central Hospital, Abha 31421, Kingdom of Saudi Arabia.
Department of Microbiology, College Of Medicine, King Khalid University, Abha 31421, Kingdom of Saudi Arabia.


A 5-year-old female child presented with fever of 1-week duration after visiting a malaria endemic zone without antimalarial prophylaxis. The patient presented with respiratory distress, decreased level of consciousness and high-grade fever. An elevated parasitaemia reaching 800,000/μl was observed. Antimalarial therapy was initiated with artesunate being administered intravenous (IV) along with IV clindamycin. Contrary to the expectations, there was no resolution of fever. Following a week of unresolved fever, the drug therapy was revised and altered to IV quinine dihydrochloride and IV clindamycin. Emergence of non-responsiveness to artesunate in Saudi Arabia is an alarming sign and requires revision of management protocols.

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