Post-treatment haemolysis in severe imported malaria after intravenous artesunate: case report of three patients with hyperparasitaemia.
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Post-treatment haemolysis in severe imported malaria after intravenous artesunate: case report of three patients with hyperparasitaemia. / Rolling, Thierry; Schmiedel, Stefan; Wichmann, Dominic; Wittkopf, Dieter; Burchard, Gerd-Dieter; Cramer, Jakob.
In: MALARIA J, Vol. 11, 2012, p. 169.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Post-treatment haemolysis in severe imported malaria after intravenous artesunate: case report of three patients with hyperparasitaemia.
AU - Rolling, Thierry
AU - Schmiedel, Stefan
AU - Wichmann, Dominic
AU - Wittkopf, Dieter
AU - Burchard, Gerd-Dieter
AU - Cramer, Jakob
PY - 2012
Y1 - 2012
N2 - Parenteral artesunate has been shown to be a superior treatment option compared to parenteral quinine in adults and children with severe malaria. Little evidence, however, is available on long-term safety. Recently, cases of late-onset haemolysis after parenteral treatment with artesunate have been reported in European travellers with imported Plasmodium falciparum malaria. Therefore, an extended follow-up of adult patients treated for severe imported malaria was started in August 2011 at the University Medical Center Hamburg-Eppendorf. Until January 2012, three patients with hyperparasitaemia (range: 14-21%) were included for analysis. In all three patients, delayed haemolysis was detected in the second week after the first dose of intravenous artesunate. Reticulocyte production index remained inadequately low in the 7 - 14 days following the first dose of artesunate despite rapid parasite clearance. Post-treatment haemolysis after parenteral artesunate may be of clinical relevance in particular in imported severe malaria characterized by high parasite levels. Extended follow-up of at least 30 days including controls of haematological parameters after artesunate treatment seems to be indicated. Further investigations are needed to assess frequency and pathophysiological background of this complication.
AB - Parenteral artesunate has been shown to be a superior treatment option compared to parenteral quinine in adults and children with severe malaria. Little evidence, however, is available on long-term safety. Recently, cases of late-onset haemolysis after parenteral treatment with artesunate have been reported in European travellers with imported Plasmodium falciparum malaria. Therefore, an extended follow-up of adult patients treated for severe imported malaria was started in August 2011 at the University Medical Center Hamburg-Eppendorf. Until January 2012, three patients with hyperparasitaemia (range: 14-21%) were included for analysis. In all three patients, delayed haemolysis was detected in the second week after the first dose of intravenous artesunate. Reticulocyte production index remained inadequately low in the 7 - 14 days following the first dose of artesunate despite rapid parasite clearance. Post-treatment haemolysis after parenteral artesunate may be of clinical relevance in particular in imported severe malaria characterized by high parasite levels. Extended follow-up of at least 30 days including controls of haematological parameters after artesunate treatment seems to be indicated. Further investigations are needed to assess frequency and pathophysiological background of this complication.
KW - Germany
KW - Humans
KW - Male
KW - Travel
KW - Female
KW - Middle Aged
KW - Young Adult
KW - Hemolysis
KW - Antimalarials/administration & dosage/adverse effects
KW - Artemisinins/administration & dosage/adverse effects
KW - Malaria, Falciparum/complications/drug therapy
KW - Parasitemia/complications/drug therapy
KW - Germany
KW - Humans
KW - Male
KW - Travel
KW - Female
KW - Middle Aged
KW - Young Adult
KW - Hemolysis
KW - Antimalarials/administration & dosage/adverse effects
KW - Artemisinins/administration & dosage/adverse effects
KW - Malaria, Falciparum/complications/drug therapy
KW - Parasitemia/complications/drug therapy
U2 - 10.1186/1475-2875-11-169
DO - 10.1186/1475-2875-11-169
M3 - SCORING: Journal article
VL - 11
SP - 169
JO - MALARIA J
JF - MALARIA J
SN - 1475-2875
ER -
