Failure of artemether-lumefantrine therapy in travellers returning to Belgium with Plasmodium falciparum malaria: an observational case series with genomic analysis
Journal of Travel Medicine·
- DOI
- 10.1093/jtm/taad165
- PMID
- 38157311
- PMCID
- —
- OpenAlex
- W4390393587
- Study type
- Journal article
- Publisher
- Oxford University Press (OUP)
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings identify treatment-failure cases among travellers returning from sub-Saharan Africa and describe genomic resistance markers detected in those cases. The authors state that systematic genomic monitoring among international travellers with P. falciparum malaria, particularly after treatment failure, is needed.
Structured evidence summary
Research question
The study examined the clinical and genomic characteristics of Plasmodium falciparum malaria cases in Belgium in which artemether-lumefantrine treatment failure was reported.
Study design
This was an observational case series based on a review of travel-related malaria cases confirmed at the Institute of Tropical Medicine in Antwerp. Initial and persistent or recurrent samples underwent next-generation sequencing.
Population and setting
The series included eight travellers returning to Belgium from sub-Saharan Africa between July 2022 and June 2023 whose P. falciparum infections were reported to persist beyond Day 3 or recur from Day 7 to Day 42 despite adequate drug intake. Six of the eight travellers had been visiting friends and relatives.
Main findings
Eight treatment-failure cases were identified: one early failure and seven late failures. Resistance-associated mutations were identified in all analysed blood samples; reported findings included PfKelch13 mutations in two travellers, additional changes potentially affecting artemisinin susceptibility in three cases, lumefantrine susceptibility in six cases, and proguanil susceptibility in all eight cases. The abstract reports favourable outcomes after alternative treatment regimens.
Public-health relevance
The findings identify treatment-failure cases among travellers returning from sub-Saharan Africa and describe genomic resistance markers detected in those cases. The authors state that systematic genomic monitoring among international travellers with P. falciparum malaria, particularly after treatment failure, is needed.
Important limitations
The supplied abstract describes a small observational case series of eight reported failures from a national reference laboratory, without a comparator group or population-level denominator. This summary is limited to the supplied single-article abstract and metadata; the original paper is required for decision-grade interpretation of case ascertainment, sequencing coverage, and the clinical significance of the detected mutations.
GIDS interpretation
This article is discoverable under malaria, P. falciparum, genomic epidemiology, surveillance, travel medicine, treatment, and Belgium. It provides contextual evidence about reported treatment-failure cases and associated genomic findings, but does not establish or confirm a current surveillance signal.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 13 auditable classifier relationships to diseases, places, topics, and study design.