Abstract
BackgroundParenteral artesunate is the treatment of choice for severe malaria. Recently, haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries.MethodsTo assess these potential safety concerns in African children, in whom most deaths from malaria occur, an open-labelled, randomized controlled trial was conducted in Kinshasa, Democratic Republic of Congo. 217 children aged between 6 months and 14 years with acute uncomplicated falciparum malaria and parasite densities over 100,000/μL were randomly allocated to intravenous artesunate or quinine, hospitalized for 3 days and then followed for 42 days.ResultsThe immediate reduction in haemoglobin was less with artesunate than with quinine: median (IQR) fall at 72 h 1.4 g/dL (0.90–1.95) vs. 1.7 g/dL (1.10–2.40) (p = 0.009). This was explained by greater pitting then recirculation of once infected erythrocytes. Only 5% of patients (in both groups) had a ≥ 10% reduction in haemoglobin after day 7 (p = 0.1). One artesunate treated patient with suspected concomitant sepsis had a protracted clinical course and required a blood transfusion on day 14.ConclusionsClinically significant delayed haemolysis following parenteral artesunate is uncommon in African children hospitalised with acute falciparum malaria and high parasitaemias.Trial registrationClinicalTrials.gov; Identifier: NCT02092766 (18/03/2014)
Highlights
Parenteral artesunate is the treatment of choice for severe malaria
Returned travellers constitute only a very small fraction of the global burden of severe malaria. Are these observations in travellers of clinical relevance to African children, who carry more than 90% of the global malaria disease burden, and for whom life-threatening anaemia is a common clinical presentation of falciparum malaria? Severe malarial anaemia in childhood is associated with significant mortality both in hospital and after discharge [9]
As haemolytic anaemia is the pathological hallmark of all malaria infections, and severe anaemia is a common feature of severe malaria, dissecting disease from drug-associated mechanisms is difficult
Summary
Haemolytic anaemia occurring 1 to 3 weeks after artesunate treatment of falciparum malaria has been reported in returning travellers in temperate countries. Returned travellers constitute only a very small fraction of the global burden of severe malaria. Are these observations in travellers of clinical relevance to African children, who carry more than 90% of the global malaria disease burden, and for whom life-threatening anaemia is a common clinical presentation of falciparum malaria? To investigate the pathogenesis of anaemia in African children and whether post-artesunate haemolytic anaemia is a significant problem, a randomised comparison was conducted of the immediate and delayed haematological responses to parenteral artesunate and quinine in children hospitalised with high falciparum parasitaemias
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
