Malaria 'breakthroughs' and resistance to chloroquine in Africa. Case reports

Four cases of Plasmodium falciparum malaria are presented. These cases are typical of chloroquine resistant malaria, with their pattern of 'breakthrough' malaria despite chloroquine prophylaxis, absence of response to therapeutic doses of chloroquine and recrudescence of the malarial parasites. These cases should alert physicians in other parts of the world, who may have to treat travelers from Central and West Africa, and particularly from the Ivory Coast, to the possibility that the malaria contracted in these areas may be chloroquine-resistant. The most effective drug in these cases appears to be a combination of sulphadoxine and pyrimethamine.