Skip directly to search Skip directly to A to Z list Skip directly to site content
CDC Home

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 A1

Characteristics of 25 patients treated with intravenous artesunate for severe malaria, Europe, January 2006–June 2010*

Patient no. Age, y/ sex Status Travel destination Initial parasitemia, % Parasite clearance, h Criteria for severe malaria Therapy Cumulative dose, mg/kg IV artesunate treatment duration, d Treatment-associated hemolysis Other complications Other medical conditions
1
62/F
VFR
Chad
9.5
NA†
Hyperparasitemia, severe anemia
Quinine, 1 dose IV† and artesunate‡/ doxycycline IV, oral artesunate/ doxycycline from day 4
4.8
3
No
Hypotonia, bradycardia associated with quinine
None
2
63/M
TR
Kenya
0.5
115
Cerebral malaria, respiratory failure, acute renal failure
Artesunate‡/ doxycycline IV
13.6
6
No
Shock, respiratory failure, renal failure,
critical illness, neuropathy
Atrial fibrillation,
peripheral arterial occlusive disease
3
46/M
TR
Cameroon
10.0
134
Hyperparasitemia, acute renal failure, cerebral malaria, anemia
Artesunate§/ doxycycline IV
8.4
6
No
Shock
Chronic hepatitis C
4
46/F
TR
India
1.0
118
Cerebral malaria
Artesunate§¶/ doxycycline IV plus artemether/ lumefantrine po from day 4
7.2
3
No
Shock
Arterial hypertension
5
63/M
TR
India
17.0
54
Hyperparasitemia, acute renal failure
Artesunate§/ doxycycline IV plus artemether/ lumefantrine po from day 4
6
3
No
Urinary tract infection,
sepsis
Gastroenteritis
6
30/F
TR
India
20.0
79
Hyperparasitemia
Artesunate§/ doxycycline IV for 7 d
12
7
Yes
None
None
7
54/F
TR
Burkina Faso
20.0
158
Hyperparasitemia, cerebral malaria
Artesunate§/ doxycycline IV
12
7
Yes
None
HIV infection
8
35/M
VFR
Ghana
10.0
80
Hyperparasitemia
Artesunate§/ doxycycline IV plus artemether/lumefantrine po from day 3
3.6
2
No
None
None
9
32/M
VFR
Ghana
30.0
104
Hyperparasitemia
Artesunate 2.4 mg/kg,# atovaquone/ proguanil on day 5
12
4
Yes
None
None
10
36/F
VFR
Guinea-Bissau
9.0
94
Hyperparasitemia
Artesunate§**/ doxycycline IV
13.2
7
No
None
None
11
46/M
TR
Liberia
4.0
48
Renal failure, jaundice
Artesunate#
19.2
7
Yes
None
Diabetes mellitus
12
47/F
TR
Ghana
51.0
57
Hyperparasitemia, cerebral malaria
Artesunate, 2.4 mg/kg,# clindamycin,†† followed by artemether/ lumefantrine from day 3
9.6
2
No
None
None
13
19/M
VFR
Chad
30.0
NA‡‡
Hyperparasitemia, hyperbilirubinemia, cerebral malaria
Artesunate#‡‡/ doxycycline IV plus artemether/ lumefantrine from day 3
7.2
1
No
Shock, vasopressor treatment
None
14
58/F
TR
Gambia
6.0
60
Cerebral malaria, respiratory failure, shock, hyperparasitemia
Artesunate§/ atovaquone/ proguanil
7.2
6
No
Renal failure, shock, vasopressor treatment, acidosis
None
15
54/M
TR
Sierra Leone
6.0
36§§
Shock, acidosis, jaundice, hyperparasitemia
Artesunate§/ atovaquone/ proguanil
5.4
4
No
Sepsis
None
16
69/M
TR
Gambia
6.0
36§§
Renal failure, shock, jaundice, hyperparasitemia
Artesunate§/ mefloquine
7.2
3
No
Sepsis
Diabetes mellitus
17
64/F
TR
Sierra Leone
3.0
12§§
Cerebral malaria
Artesunate‡/ atovaquone/ proguanil
7.2
4
No
None
None
18
47/M
TR
Guinea-Bissau
5.0
36§§
Hyperparasitemia
Artesunate§/ atovaquone/ proguanil
3.6
2
No
Urinary tract infection
None
19
32/F
TR
Burundi
3.5
36§§
Hyperbilirubinemia
Artesunate§/ mefloquine
6
4
No
None
None
20
25/M
VFR
Guinea
9.0
88
Hyperparasitemia, hyperbilirubinemia
Artesunate#/ artemether/ lumefantrine
12
4
No
None
None
21
35/M
VFR
Togo
20.0
38
Hyperparasitemia
Artesunate#/ artemether/ lumefantrine
7.2
2
No
None
HIV infection
22
55/M
TR
Kenya
8.0
70
Hyperparasitemia
Artesunate#/ artemether/ lumefantrine
7.2
2
No
None
None
23
49/M
TR
Angola
9.0
35
Hyperparasitemia, renal failure, jaundice, DIC
Artesunate#/ doxycycline, followed by artemether/ lumefantrine on day 5¶¶
12
4
Yes
None
None
24
2/F
TR
Kenya
8.0
48
Hyperparasitemia
Artesunate#/ artemether/ lumefantrine
4.8
1
No
None
None
25 34/F TR Cameroon 10.0 NA Hyperparasitemia, renal failure, shock Artesunate#/ doxycycline IV plus artemether/ lumefantrine 9.6 3 Yes Vasopressor treatment, sepsis None

*IV, intravenous; VFR, travelers born in malaria-endemic countries visiting friends and relatives; NA, not available; TR, returning travelers of European origin; po, per os; DIC, disseminated intravascular coagulation.
†Patient received IV artesunate after treatment was begun with IV quinine/doxycycline. The treatment regimen was changed because of quinine-associated hypotension and bradycardia during the first dose of quinine.
‡Artesunate, 1.2 mg/kg, all doses.
§Artesunate, 2.4 mg/kg, first dose; 1.2 mg/kg, subsequent doses.
¶Patient received chloroquine/primaquine for 4 days before admission.
#Artesunate, 2.4 mg/kg, all doses.
**Patient received 1 dose of artemether/lumefantrine before transfer to avoid a delay in treatment initiation.
††Clindamycin, 20 mg/kg/d, divided into 4 doses (20).
‡‡Patient received 1 dose of IV quinine before transfer to the Berlin treatment center to avoid a delay in treatment initiation.
§§Parasitemia level <1%.
¶¶One dose artemether/lumefantrine was given on day 2 before IV artesunate treatment was given because of deteriorating clinical status of the patient.

Main Article

Top of Page

USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO