Volume 14, Number 11—November 2008
Letter
Severe Malaria and Artesunate Treatment, Norway
Table
Patient no. (gender/ age, y) | Reason for travel | Country of disease acquisition | WHO severe malaria criteria | Days from symptom onset to therapy | Initial treatment | Length of hospital stay, d | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
Parasitemia level, % |
|||||||||||
Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | |||||||
1 (M/37) | Tourism | Ghana | Impaired consciousness, bilirubin† 53, hyperparasitemia | 10 | AS + D | 4 | <1 | 0‡ | 4 | ||
2 (M/45) | VFR | Mali | Hyperparasitemia | 4 | AS + D | 5 | <1‡ | <1 | NA | 0 | 4 |
3 (M/25) | VFR | Ghana | Impaired consciousness, hematemesis, hemoglobinuria, lactate 3.2,§ hyperparasitemia | 5 | AS + D | 15 | 7 | <1 | 0‡ | 3 | |
4 (M/41) | Tourism | Ghana | Coma, shock, hemoglobinuria, bilirubin 241, hyperparasitemia | 5 | AS + D | 20 | 3 | <1 | NA | 0‡ | 5 |
5 (F/32) | Immigration | Nigeria | Impaired consciousness, bilirubin 50, hyperparasitemia | 3 | AS + C (patient pregnant) | 7 | 0 | NA‡ | 3 | ||
6 (M/46) | Business | Nigeria | Impaired consciousness, creatinine† 309, bilirubin 58, hyperparasitemia | 6 | Quinine 1,200 mg loading dose, then AS + D | 30 | 5 | 0.5‡ | 0 | 7 | |
7 (M/35) | Tourism | Myanmar | Impaired consciousness, hyperparasitemia | 10 | AS | 4 | <1 | 0‡ | 0 | 5 | |
8 (F/38) | VFR | Liberia | Shock | 7 | AS + D | 1 | <1‡ | 0 | 0 | 3 | |
9 (M/55) | VFR | Guinea | Creatinine 315, bilirubin 118, hyperparasitemia | 4 | AS + D | 6 | <1 | 0‡ | 4 |
*WHO, World Health Organization; AS, artesunate; D, doxycycline; VFR, visiting friends and relatives; NA, not available; C, clindamycin.
†µmol/L (bilirubin reference range 5–25; creatinine reference range 60–105).
‡Day when intravenous artesunate was discontinued.
§mmol/L (reference range 0.5–2.2).
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