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JAC Advance Access originally published online on May 2, 2007
Journal of Antimicrobial Chemotherapy 2007 59(6):1197-1199; doi:10.1093/jac/dkm104
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© The Author 2007. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
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Chloroquine-resistant Plasmodium falciparum infections among UK travellers returning with malaria after chloroquine prophylaxis

Colin J. Sutherland1,2,*, Thomas Haustein1, Nahla Gadalla3, Margaret Armstrong1, Justin F. Doherty1,3 and Peter L. Chiodini1,2

1 Hospital for Tropical Diseases, London, UK 2 HPA Malaria Reference Laboratory, London School of Hygiene and Tropical Medicine, London, UK 3 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK

Received 2 December 2006; returned 25 February 2007; revised 2 March 2007; accepted 16 March 2007

* Correspondence address. Department of Clinical Parasitology, Hospital for Tropical Diseases, Mortimer Market, Capper St, London WC1E 6AU, UK. Tel: +44-20-7387-4411 ext. 5965; Fax: +44-20-7383-0041; E-mail: colin.sutherland{at}lshtm.ac.uk

Objectives: We sought to identify chloroquine-resistant Plasmodium falciparum parasites among 66 travellers who presented in the UK with malaria.

Methods: A multiplex real-time PCR assay was devised to identify wild-type and two distinct chloroquine-resistance-associated alleles of the pfcrt gene.

Results: Those with documented use of chloroquine/proguanil prophylaxis were more likely to carry parasites with resistance-associated alleles of pfcrt than were patients who had been using antimalarials other than chloroquine (92.9% versus 37.5%; P = 0.011). We also found evidence that people reporting optimum compliance with chloroquine prophylaxis during malaria exposure were more common among malaria cases than were those reporting optimum compliance with other regimens (OR 3.85, 95% CI 1.61–9.69; P = 0.0008).

Conclusions: Chloroquine, known to be failing as therapy for falciparum malaria worldwide, is also failing to provide adequate malaria prophylaxis for travellers.

Keywords: pfcrt , real-time PCR , compliance


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