Table 6 Phenotypic and genotypic characteristics of late treatment failure and evaluation of AMLF rescue therapy.

From: Artemisinin combination therapy fails even in the absence of Plasmodium falciparum kelch13 gene polymorphism in Central India

Case

Drug

Day of recurrence

Parasite load on recurrence

Fever (°C)

PCR correction

pfk13 allele

pfdhfr allele

pfdhps allele

Rescue therapy with AMLF

ACPR

ETF

LTF

Case 1

ASSP

5

3642/µL

38.6

Recrudescence

Wild

AICNI

AGKAA

Case 2

ASSP

7

5082/µL

38

Recrudescence

Wild

ANRNI

SGKGT

Case 3

ASSP

21

27,419/µL

39.1

Recrudescence

N29L

AICNI

AGKAA

Case 4

ASSP

11

11,026/µL

39.4

Recrudescence

Wild

AICNI

AGKAA

Case 5

ASSP

7

4957/µL

38.4

Recrudescence

A675V

ANRNI

AGKAA

Case 6

ASSP

28

870/µL

37.9

Recrudescence

Wild

AIRNI

SGKGT

Case 7

ASSP

35

7350/µL

38.1

Recrudescence

Wild

ANRNI

SGKGT

Case 8

ASSP

32

512/µL

38.3

Recrudescence

Wild

ANRNI

AGKAA

Case 9

ASSP

28

51,154/µL

40.1

Re-infectiona

Wild

AIRNI

SGKGT

Case10

ASSP

21

16,822/µL

39.3

Recrudescence

Wild

AIRNI

AGKAA

Case11

ASSP

35

3092/µL

38

Re-infectiona

Wild

AIRNI

SGKGT

Case12

ASSP

14

5168/µL

38.8

Recrudescence

Wild

AIRNI

SGKGT

  1. Underlined codons are mutant codons. ACPR, ETF and LTF respectively stand for adequate clinical parasitological response, early treatment failure and late treatment failure, whereas ASSP stand for artesunate-sulfadoxine-pyrimethamine and AMLF stands for artemether-lumefantrine. Parasite load was expressed as number of parasite/ micro liter of blood.
  2. aAfter PCR correction, case 9 and case 11 were identified as the case of parasite re-infection.