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Volume 17, Number 5—May 2011

Synopsis

Intravenous Artesunate for Severe Malaria in Travelers, Europe

Thomas ZollerComments to Author , Thomas Junghanss, Annette Kapaun, Ida Gjørup, Joachim Richter, Mats Hugo-Persson, Kristine Mørch, Behruz Foroutan, Norbert Suttorp, Salih Yürek, and Holger Flick
Author affiliations: Author affiliations: Charité Universitätsmedizin, Berlin, Germany (T. Zoller, N. Suttorp, S. Yürek, H. Flick); Universitätsklinikum Heidelberg, Heidelberg, Germany (T. Junghanss, A. Kapaun); The State University Hospital, Copenhagen, Denmark (I. Gjørup); Universitätsklinikum Düsseldorf, Düsseldorf, Germany (J. Richter); Hospital of Helsingborg, Helsingborg, Sweden (M. Hugo-Persson); Haukeland University Hospital, Bergen, Norway (K. Mørch); Armed Forces Hospital, Berlin (B. Foroutan)

Main Article

Table

Laboratory test results for 6 patients with posttreatment hemolysis who had been treated with intravenous artesunate for severe malaria, Europe, January 2006–June 2010*

Patient no. Initial parasitemia level, % Levels
at first examination
Treatment duration, d Parasite clearance, d Levels
at end of treatment
Day of diagnosis of hemolysis† Levels at diagnosis of hemolysis
Other test results
Hb, g/dL LDH, U/L Hb, g/dL LDH, U/L Hb, g/dL LDH, U/L
6
30
11.3
765
7
4
7.7
317
15
5.7
1,437
Coombs negative, reticulocytes 10.2%, G6PD deficiency ruled out
7
20
13.2
1,359
7
7
8.2
NA
32‡
6.1
805
None
9
30
13.4
1,033
4
5
7.6
650
19‡
5.3
672
None
11
4
13.4
904
7
2
9.8
311
15
7.8
660
Standard reticulocyte count
23
9
15.5
490
4
2
11.1
571
15
5.7
1,489
Reticulocytes >2× upper reference value, haptoglobin <0.1g/L, Coombs negative
25 10 14.2 570 3 NA 7.8 454 16‡ 5.8 444 Reticulocytes 3× upper reference value, haptoglobin <0.08 g/L (day14), G6PD deficiency ruled out

*Hb, hemoglobin; LDH, lactate dehydrogenase; G6PD, gluose-6-phosphate dehydrogenase; NA, not available.
†After first dose of artesunate.
‡Patients had persistent hemolytic activity after the end of malaria treatment.

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