Volume 17, Number 5—May 2011
Synopsis
Intravenous Artesunate for Severe Malaria in Travelers, Europe
Table A1
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.
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