We have had a few recent reports of cases of malaria with probable artemisinin failure submitted by Eli Schwartz (ISR). Preliminary investigations suggest that the failures are not associated with the previously described “kelch” mutations associated with artemisinin resistance. Most of these cases have presented as a relatively late recrudescence of parasitemia. We have had a small number of similar cases reported from various sites over recent years.
This alert serves as a reminder that we have diagnostic codes for clinical treatment failure: 618 (non-falciparum chloroquine treatment failure), 156 (artemisinin failure), 697 (atovaquone/proguanil failure), 735 (mefloquine failure), 620 (primaquine failure) and 563 (quinine failure). Confirmed cases require molecular testing for resistance mechanisms and documentation of therapeutic drug levels. Otherwise, they should be entered as “probable” cases. For affiliate sites not entering data into our network database, please notify us of any such cases directly by email to geosentinel@geosentinel.org.
We have noted that some cases are not being documented in the database because after a late recrudescence, sites are not returning to the record to add the new codes for treatment failure. Surveillance for malaria treatment failure is a priority for our network. In addition, we are working towards finalizing a research project which will further explore the epidemiology and implications of treatment failure, which will be open to all sites.
Documentation of prophylaxis failure is built into the small questionnaire linked to the regular malaria diagnostic codes.
If your site is not able to perform molecular testing for resistance or evaluate drug levels, we encourage you to store whole blood and serum from the time of patient presentation. It may become possible for us to assist your site to obtain such testing to confirm the resistance mechanism.
As travel begins to ramp up, we are seeing increasing malaria cases. Please help us optimize this important surveillance function.
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We have had a few recent reports of cases of malaria with probable artemisinin failure submitted by Eli Schwartz (ISR). Preliminary investigations suggest that the failures are not associated with the previously described “kelch” mutations associated with artemisinin resistance. Most of these cases have presented as a relatively late recrudescence of parasitemia. We have had a small number of similar cases reported from various sites over recent years.
This alert serves as a reminder that we have diagnostic codes for clinical treatment failure: 618 (non-falciparum chloroquine treatment failure), 156 (artemisinin failure), 697 (atovaquone/proguanil failure), 735 (mefloquine failure), 620 (primaquine failure) and 563 (quinine failure). Confirmed cases require molecular testing for resistance mechanisms and documentation of therapeutic drug levels. Otherwise, they should be entered as “probable” cases. For affiliate sites not entering data into our network database, please notify us of any such cases directly by email to geosentinel@geosentinel.org.
We have noted that some cases are not being documented in the database because after a late recrudescence, sites are not returning to the record to add the new codes for treatment failure. Surveillance for malaria treatment failure is a priority for our network. In addition, we are working towards finalizing a research project which will further explore the epidemiology and implications of treatment failure, which will be open to all sites.
Documentation of prophylaxis failure is built into the small questionnaire linked to the regular malaria diagnostic codes.
If your site is not able to perform molecular testing for resistance or evaluate drug levels, we encourage you to store whole blood and serum from the time of patient presentation. It may become possible for us to assist your site to obtain such testing to confirm the resistance mechanism.
As travel begins to ramp up, we are seeing increasing malaria cases. Please help us optimize this important surveillance function.