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    Resistance to antimalarial drugs has been documented in all classes of antimalarials including artemisinin derivatives and it is a major threat to malaria control. When given the second time in a different combination, he had recrudescence with recurrence of fever twelve days after the medicines were stopped.

    Also another interesting fact that emerged in this case was the persistent diagnostic dilemma due to negativity of malarial parasite on microscopy as well as by RDT, optiMAL based on Plasmodium lactate dehydrogenase LDH.

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    There are concerns about availability of fake drugs in the market which lead to treatment failure and propagate resistance. Artemisinin compounds used in our case both the times were from reputed drug firms in doses recommended as per the body weight of the patient and were tolerated well.

    The question that remains to be answered is whether this case report is heralding the beginning of ACT resistant malaria in India; this needs further investigation on a large scale in malaria endemic areas.

    References WHO guidelines for treatment of malaria. Geneva — World health organisation,. This will give you a general idea of what you need to consider for your trip Click here for more information on routine, recommended and required vaccinations How can I prepare for travel to high altitude?

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