A CASE OF TROPICAL ILLNESS MANAGED IN THE MEDICAL ICU WITH AN INVESTIGATIONAL NEW DRUG

Abstract

SESSION TITLE: Case Report Semifinalists 3 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Rates of international travel are increasing along with increasing exposure to tropical diseases. It is of importance to maintain knowledge of common tropical diseases and treatment options. CASE PRESENTATION: A 30-year-old male, who returned a week prior from admission, from a vocational trip to Nigeria. Patient presented with symptoms of headache, fever, nausea, vomiting, abdominal pain and diarrhea. Patient was septic but otherwise hemodynamically stable, with presenting labs demonstrating profound thrombocytopenia with low haptoglobin (table 1) and presence of malaria on Wright-Giemsa stain. Blood smear demonstrated 17% Plasmodium Falciparum paracitemia. The Center of Disease Control(CDC) was contacted. Patient was started on treatment with intravenous(IV) quinidine and doxycycline and admitted to the Medical Intensive Care Unit(MICU) for further monitoring. Due to lack of available IV quinidine to complete therapy the decision was made to transition to IV artesunate and continued on doxycycline. Hospital course remained uncomplicated with quick resolution of parasitic loads (<1%). DISCUSSION: Malaria with Plasmodium Falciparum occurring in certain geographical areas, including Nigeria, are categorized by the CDC as a chloroquine resistant. Four applicable pharmacological therapies are available in such cases: atovaquone-proguanil, artemether-lumefantrine, quinine in combination with doxycycline, tetracycline or clindamycin and mefloquine. Quinine is the only FDA approved IV medication for treatment of severe malaria. The CDC defines severe malaria by the presence of one of more specifically defined clinical signs and symptoms and/or parasitemia of >5%. Our patient was stratified into a category of severe malaria by presence of a paracitemia of 17%. Per CDC recommendations severe malaria should be treated with IV antimalarial medication. World Health Organization recommends artesunate over quinine therapy for severe malaria. The FDA has approved artesunate as an investigational option in certain individuals who qualify. CONCLUSIONS: Artesunate is an effective alternative treatment option for individuals with severe malaria. We demonstrate a case of successful treatment of severe chloroquine resistant plasmodium falciparum malaria with artesunate. Reference #1: Centers for Disease Control and Prevention. (2018). Treatment of Malaria: Guidelines For Clinicians (United States) Reference #2: Dilip R. Karnad, MD, Guy A. Richards, MD PhD, Gisele Sampaio Silva, MD, Pravin Amin, MD. Tropical diseases in the ICU: A syndromic approach to diagnosis and treatment. Journal of Critical Care 46(2018)119-126 DISCLOSURES: No relevant relationships by Shozab Ahmed, source=Web Response No relevant relationships by Monika Kakol, source=Web Response