SHORT REPORT - PRIMAQUINE-TOLERANT PLASMODIUM-VIVAX IN AN ITALIAN TRAVELER FROM GUATEMALA

Plasmodium vivax infections caused by strains with low sensitivity to primaquine are widespread in the Western Pacific and Southeast Asia, a nd have been recently reported from Central America as well. We report a case of primaquine failure in a P. vivax infection acquired in Guat emala. A 28-year-old Italian woman developed two months after returnin g from Guatemala a vivax malaria attack that was treated with a standa rd chloroquine course (1,500 mg over three days) combined with primaqu ine (15 mg/day for 14 days). Two months later, she had a relapse that was again treated with chloroquine and primaquine at the same doses. A fter two more months, a second relapse occurred: this time primaquine (30 mg/day for 14 days was administered; the patient remained well dur ing a follow-up period of six months and all parasitologic examination results were negative. Doses of primaquine as high as 6 mg/kg total d ose may be indicated in the treatment of vivax malaria cases from Cent ral America.