Patient was given chloroquine and doxycycline for 7 days. Patients fever decreases in 4 days, but, peripheral smear showed occasional gametocytes of plasmodium falciparum. This type of drug resistance is –
**Core Concept**
Chloroquine and doxycycline are antimalarial medications used to treat Plasmodium falciparum infections. However, resistance to these drugs can develop, leading to treatment failure. The mechanism of resistance involves changes in the parasite's ability to accumulate the drug within its cells.
**Why the Correct Answer is Right**
The presence of gametocytes in the peripheral smear after treatment with chloroquine and doxycycline suggests that the patient has developed resistance to these drugs. This is known as "recrudescence," where the parasite population is resistant to the treatment, leading to a relapse of symptoms. Chloroquine works by accumulating in the food vacuole of the parasite, where it inhibits the enzyme heme polymerase, leading to the accumulation of toxic heme. Resistance to chloroquine is often associated with mutations in the PfCRT gene, which encodes a protein involved in the transport of chloroquine into the parasite.
**Why Each Wrong Option is Incorrect**
* **Option A:** Clearance of the parasite from the blood does not necessarily indicate the absence of resistance.
* **Option B:** The presence of gametocytes is a specific indicator of resistance, not just a normal response to treatment.
* **Option C:** The use of doxycycline alone would not be enough to determine resistance to chloroquine.
**Clinical Pearl / High-Yield Fact**
Recrudescence can occur due to inadequate treatment duration, incomplete treatment, or resistance to the antimalarial drug. It's essential to monitor for signs of treatment failure and adjust treatment plans accordingly.
**Correct Answer:** B. Recrudescence.