Abstract
BackgroundGlobally, malaria is one of the six major causes of deaths from communicable diseases. In South Africa, malaria is known to be endemic in three provinces. Two large trials, AQUAMAT and SEAQUAMAT, demonstrated the superiority of intravenous (IV) artesunate compared to quinine. A systematic review (including the above trials) demonstrated a mortality benefit for adult patients treated with artesunate, but included studies that were conducted in Asia with no adult data available for Africa. Given the lack of local data, we conducted this study to investigate the use of artesunate for the treatment of severe malaria at two academic adult intensive care units (ICUs) in Johannesburg.MethodsWe undertook a retrospective patient record review. All patients admitted to the two ICUs and treated for severe malaria using artesunate were included. The study period extended from April 2010 to April 2014. The primary outcome was to determine the observed mortality and relate it to the predicted mortality based on the Acute Physiology and Chronic Health Evaluation (APACHE II) severity of illness score. The ratio of the observed mortality to the expected mortality based on the APACHE II severity of illness score provides a standardised mortality ratio (SMR). Clinical and laboratory parameters data were analysed.ResultsThere were 56 patients included in the study, of which 40 were male (71.4%). The mean APACHE II score was 19 (standard deviation 5.4). We observed a lower than predicted mortality rate of 21.4% (SMR 0.66). Human immunodeficiency virus (HIV) was the most prevalent comorbidity (32%). There was no travel history in 26.8% of patients. Heart rate, respiratory rate and Glasgow Coma Scale (GCS) all improved significantly from admission to the time of discharge (p ≤ 0.01). Acidaemia, bilirubin, urea and bleeding risk (platelet count) also improved (p ≤ 0.01). Mechanical ventilation was associated with an increased risk of death (OR 35; CI 7.0–182).ConclusionIn this retrospective two-centre study, IV artesunate was associated with a lower than predicted mortality in adult patients with severe malaria requiring ICU admission.
Highlights
Malaria is one of the six major causes of deaths from communicable diseases
According to the 2013 World Health Organization (WHO) World Malaria Report, malaria is a major cause of mortality and morbidity in malaria-endemic areas of the world
It is noteworthy that a systematic review that demonstrated a mortality benefit for adult patients treated with artesunate included studies that were conducted in Asia with no adult data from Africa.[11]
Summary
Malaria is one of the six major causes of deaths from communicable diseases. A systematic review (including the above trials) demonstrated a mortality benefit for adult patients treated with artesunate, but included studies that were conducted in Asia with no adult data available for Africa. According to the 2013 World Health Organization (WHO) World Malaria Report, malaria is a major cause of mortality and morbidity in malaria-endemic areas of the world. In 2018, 228 million cases of malaria were estimated to have been reported throughout the world with 85% of cases in sub-Saharan Africa and India.[1] This makes malaria the second most common cause of infectious disease-related deaths in the world, after tuberculosis.[2]. Plasmodium vivax is more common in Central America and Asia.[4]
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