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

ABSTRACT

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.