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Volume 21, Number 5—May 2015

Delayed-Onset Hemolytic Anemia in Patients with Travel-Associated Severe Malaria Treated with Artesunate, France, 2011–2013

Stéphane JauréguiberryComments to Author , Marc Thellier, Papa Alioune Ndour, Flavie Ader, Camille Roussel, Romain Sonneville, Julien Mayaux, Sophie Matheron, Adela Angoulvant, Benjamin Wyplosz, Christophe Rapp, Thierry Pistone, Bénédicte Lebrun-Vignes, Eric Kendjo, Martin Danis, Sandrine Houzé, François Bricaire, Dominique Mazier, Pierre Buffet, Eric Caumes, and French Artesunate Working Group
Author affiliations: Université Pierre et Marie Curie, Paris, France (S. Jauréguiberry, M. Thellier, P.A. Ndour, C. Roussel, M. Danis, D. Mazier, P. Buffet, E. Caumes); Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (APHP), Paris (S. Jauréguiberry, M. Thellier, F. Ader, J. Mayaux, B. Lebrun-Vignes, M. Danis, F. Bricaire, D. Mazier, P. Buffet, E. Caumes); Centre National de Référence du Paludisme, Paris (S. Jauréguiberry, M. Thellier, E. Kendjo, M. Danis, D. Mazier, P. Buffet); Hôpital Bichat, APHP, Paris (R. Sonneville, S. Matheron, S. Houzé); Université Paris-Sud, Orsay, France (A. Angoulvant); Hôpital de Bicêtre, Le Kremlin Bicêtre, APHP, France (A. Angoulvant, B. Wyplosz); Hôpital d’Instruction des Armées Begin, St. Mandé, France (C. Rapp); Hôpital Pellegrin, Bordeaux, France (T. Pistone)

Main Article

Table 1

Severity of reported adverse events possibly associated with artesunate treatment of severe imported malaria in 117 patients, France, 2011–2013*

Adverse event
Grade 1, mildly severe
Grade 2, moderately severe
Grade 3, severe
Grade 4, life threatening
Cutaneous 2† 1‡ 0 0 3
Ataxia, tremor, CNS ischemia 0 2 1 1 4
Tinnitus 1 0 0 0 1
Cardiac and arterial ischemia 1 1 1 1 4
Hypertension 0 0 0 1
Elevated level of ALT 2 2 3 1 8
Hyperkalemia 1 0 0 0 1
Anemia¶ 20 11 27 17 75
Total 27 17 33 20 97

*Adverse events were obtained from medical charts and graded by using the National Institutes of Health classification for side effects ( ALT, alanine transaminase; CNS, central nervous system.
†Mild pruritus and rash.
‡Telogen effluvium.
§Regressive retinopathy.
¶Grading was done during the follow-up by using available nadir of hemoglobin. For HIV-negative patients, the severity of anemia was graded as follows: grade 1, 10.0–10.9 g/dL; grade 2, 9.0–9.9 g/dL; grade 3, 7.0–8.9 g/dL, grade 4, <7.0 g/dL. For HIV-positive patients, the severity of anemia was graded as follows: grade 1, 8.5–10.0 g/dL; grade 2.0, 7.5–8.4 g/dL; grade 3, 6.5–7.4 g/dL; grade 4, <6.5 g/dL.

Main Article

1Members of the French Artesunate Working Group are listed in the Technical Appendix.

Page created: April 17, 2015
Page updated: April 17, 2015
Page reviewed: April 17, 2015
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