Volume 17, Number 5—May 2011
Synopsis
Intravenous Artesunate for Severe Malaria in Travelers, Europe
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.


