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Volume 21, Number 5—May 2015
Research

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*

Variable
 Pattern p value
Non-PADH, n = 51†
 PADH, n = 21‡
Sex, no. (%)
M 29 (57) 11 (52) 0.8§
F
 22 (43)
 10 (48)
Age, y, median (Q1–Q3)
 42 (27–52)
 41 (31–53)
 0.7¶
Location of birth, no. (%)
Africa 31 (61) 10 (48) 0.3§
Europe, North America 18 (35) 11 (52)
South, Central America 2 (4) 0
Asia
 0
 0
Duration of illness before artesunate treatment, median d (Q1–Q3)
 4 (3–5)
 4 (3–5)
 0.8¶
Hyperparasitemia, no. (%)
>4% infected erythrocytes 28 (55) 16 (76) 0.1§
>10% infected erythrocytes
 13 (25)
 5 (24)
 1§
Parasitemia level at day 0, median % infected erythrocytes (Q1–Q3)
 5.0 (1.4–10.1)
 7.1 (3.75–14.5)
 0.1¶
Hemoglobin level, median g/dL (Q1–Q3), at day 0
 11.3 (9.6–13.1)
 13.6 (11.6–15.4)
 0.002¶
Total dose of artesunate, median mg (Q1–Q3)
 840 (540–1035)
 800 (676–955)
 0.8¶
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
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