Abstract
BackgroundMalaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria.MethodsThe European Network for Tropical Medicine and Travel Health (TropNet) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria.ResultsFrom 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections were acquired in West Africa (109/185, 59%). The proportion of patients treated with intravenous artesunate increased from 27% in 2006 to 60% in 2013. Altogether, 56 different combinations of intravenous and oral drugs were used across 28 study centres. The risk of acute renal failure (36 vs 17% p = 0.04) or cerebral malaria (54 vs 20%, p = 0.001) was significantly higher in patients ≥60 years than in younger patients. Respiratory distress with the need for mechanical ventilation was significantly associated with the risk of death in the study population (13 vs 0%, p = 0.001). Post-artemisinin delayed haemolysis was reported in 19/70 (27%) patients treated with intravenous artesunate.ConclusionThe majority of patients with severe malaria in this study were tourists or migrants acquiring the infection in West Africa. Intravenous artesunate is increasingly used for treatment of severe malaria in many European treatment centres and can be given safely to European patients with severe malaria. Patients treated with intravenous artesunate should be followed up to detect and manage late haemolytic events.
Highlights
Malaria remains one of the most serious infections for travellers to tropical countries
Intravenous artesunate is increasingly used for treatment of severe malaria in many European treatment centres and can be given safely to European patients with severe malaria
Patients treated with intravenous artesunate should be followed up to detect and manage late haemolytic events
Summary
Malaria remains one of the most serious infections for travellers to tropical countries. Kurth et al Malar J (2017) 16:57 regions, migrants visiting friends and relatives (VFR) in their previous home country are increasingly affected [2, 3] This population is less likely to seek pre-travel advice and to take anti-malarial prophylaxis [4, 5]. Criteria for the definition of severe malaria were amended by the World Health Organization (WHO) in 2006, 2010 and 2015, with regard to the definition of hyperparasitaemia [6], and numerous classification and treatment recommendations still exist across European countries. Another challenge is the transition from intravenous quinine to intravenous artesunate as first-line treatment for severe malaria. The pathophysiology of late haemolytic reactions occurring 2–6 weeks after treatment is not fully understood and harmonized guidelines for followup care of patients receiving this drug in Europe need to be developed [11, 12]
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