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Malaria research in drug development, deployment and resistance
Fake artesunate in Africa. A near death experience for an European tourist.
There is limited documented evidence directly linking malaria treatment failure to proven poor quality antimalarial medication.
Herein we present a case of Plasmodium falciparum malaria treated with fake Artesunate purchased in West Africa
In 2011 a Spanish citizen who visited Equatorial Guinea (EG) on a regular basis, attended a health centre in Malabo where she was diagnosed with slide-positive falciparum malaria and advised to buy artesunate and sulfadoxine-pyrimethamine (SP) from the local traders. She bought two boxes of “Artesunat®” 50 mg labeled as being manufactured by Mekophar, Vietnam (Figure 1), and took four tablets a day together with SP. After three days, the patient’s symptoms persisted and on returning to Navarra (Spain) was admitted to hospital and treated with the hospital’s supply of intravenous artesunate, leading to full recovery within three days.
The patient notified her doctor regarding her illness and subsequent treatment from EG. She supplied her physician with the remaining “Artesunat®”. To confirm the cause of treatment failure, he forwarded the tablets to the LSHTM analytical facility. We tested the tablets for chemical content using our qualitative Rapid Field Test (figure 2) and then confirmed the result using high performance liquid chromatography. The tablets were not found to contain the stated (artesunate) active pharmaceutical ingredient.