First Case of Emergence of Atovaquone-Proguanil Resistance in Plasmodium falciparum during Treatment in a Traveler in Comoros

DOI: 10.1128/AAC.00282-08

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TABLE 1.

In vitro drug susceptibility profiles and changes in genotyping profiles of the day 0 and day 23 P. falciparum parasites^a

Sample	Parasitemia (%)	IC₅₀ (nM) for:								P. falciparum genotyping result for gene or microsatellite locus
		CQ	QN	MQ	MDAQ	LMF	CYC	PYR	ATV	Allele group(s) of gene		Length (bp) of locus
		CQ	QN	MQ	MDAQ	LMF	CYC	PYR	ATV	msp1	msp2	7A11	C4M79	C4M69
Day 0	0.5	32	206	25.3	37.8	14.6	14	241	2.9	K1, Mad 20	3D7, FC27	124	203	393
Day 23	1.3	62	652	34.1	30.5	15.2	250	2,512	390.0	K1	3D7	94	196	336

↵ a Drug assays were performed at 1.5% hematocrit over a 60-h culture period using a [³H]hypoxanthine incorporation microtest (12). Each isolate was tested once in triplicate against serial dilutions of antimalarial drugs over the following concentration ranges: 5 to 3,200 nM for chloroquine disphosphate (CQ; Sigma, Saint Louis, MO) and quinine hydrochloride (QN; Sigma), 3.2 to 400 nM for mefloquine (MQ; Hoffman-LaRoche, Bale, Switzerland), 1.56 to 1,000 nM for monodesethylamodiaquine (MDAQ; World Health Organization, Geneva, Switzerland), 0.5 to 310 nM for lumefantrine (LMF; World Health Organization), 10 to 20,000 nM for cycloguanil (CYC; Zeneca Pharma, Reims, France), 50 to 40,000 for pyrimethamine (PYR; Sigma), and 0.3 to 12,480 for atovaquone (ATV; GlaxoSmithKline).