Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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 2

Association between selected variables and non-PADH and PADH patterns of anemia in 72 patients with severe imported malaria treated with artesunate, France, 2011–2013*

Pattern p value
Non-PADH, n = 51†
PADH, n = 21‡
Sex, no. (%)
M 29 (57) 11 (52) 0.8§
22 (43)
10 (48)

Age, y, median (Q1–Q3)
42 (27–52)
41 (31–53)
Location of birth, no. (%)
Africa 31 (61) 10 (48) 0.3§
Europe, North America 18 (35) 11 (52)
South, Central America 2 (4) 0

Duration of illness before artesunate treatment, median d (Q1–Q3)
4 (3–5)
4 (3–5)
Hyperparasitemia, no. (%)
>4% infected erythrocytes 28 (55) 16 (76) 0.1§
>10% infected erythrocytes
13 (25)
5 (24)

Parasitemia level at day 0, median % infected erythrocytes (Q1–Q3)
5.0 (1.4–10.1)
7.1 (3.75–14.5)
Hemoglobin level, median g/dL (Q1–Q3), at day 0
11.3 (9.6–13.1)
13.6 (11.6–15.4)
Total dose of artesunate, median mg (Q1–Q3)
840 (540–1035)
800 (676–955)
Artesunate first-line treatment for current severe malaria episode, no. (%) 29 (57) 15 (71) 0.3§

*PADH, postartesunate delayed-onset hemolysis; Q1–Q3, quartiles 1–3.
†Non-PADH pattern was defined by a hemoglobin nadir and a hemolysis peak occurring before day 8, with or without positive markers of hemolysis after day 8 and without a nadir or sudden drop of hemoglobin after day 8.
‡PADH pattern was defined by 1) a new drop in the hemoglobin level after day 8 of treatment initiation and the appearance or reappearance of hemolytic markers occurring any time between day 8 and the end of follow-up and/or 2) by any information in the medical chart referring to acute hemolysis occurring after day 8.
§Fisher exact test.
¶Mann-Whitney test.

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
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.