Volume 22, Number 8—August 2016
Research
Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria
Florian Kurth
, Tilman Lingscheid, Florian Steiner, Miriam S. Stegemann, Sabine Bélard, Nikolai Menner, Peter Pongratz, Johanna Kim, Horst von Bernuth, Beate Mayer, Georg Damm, Daniel Seehofer, Abdulgabar Salama, Norbert Suttorp, and Thomas Zoller
, Tilman Lingscheid, Florian Steiner, Miriam S. Stegemann, Sabine Bélard, Nikolai Menner, Peter Pongratz, Johanna Kim, Horst von Bernuth, Beate Mayer, Georg Damm, Daniel Seehofer, Abdulgabar Salama, Norbert Suttorp, and Thomas Zoller
Table
Baseline characteristics and follow-up laboratory data for patients with uncomplicated Plasmodium falciparum malaria who were given ACT*
| Characteristic | All, n = 20 | Without posttreatment hemolysis, n = 12 | With posttreatment hemolysis, n = 8 | p value | With compensated posttreatment hemolysis, n = 4 | With uncompensated posttreatment hemolysis, n = 4 | p value |
|---|---|---|---|---|---|---|---|
| Baseline | |||||||
| Age, y | 35 (26–40) | 31 (17–40) | 38 (30–43) | 0.18 | 32 (22–42) | 40 (27–46) | 0.15 |
| Children | 3/20 (15.0) | 3/12 (25.0) | 0/8 (0) | 0.24 | 0/4 (0) | 0 (0) | |
| African ethnicity | 13/20 (65.0) | 9/12 (75.0) | 4/8 (50.0) | 0.35 | 4/4 (100.0) | 0/4 (0) | 0.001 |
| Female sex | 9/20 (45.0) | 7/12 (58.3) | 2/8 (25.0) | 0.19 | 2/4 (50.0) | 0/4 (0) | 0.42 |
| Treatment with ARM/LUM | 5/20 (25.0) | 4/12 (33.3) | 1/8 (12.5) | 0.60 | 0/4 (0) | 1/4 (25.0) | 1.0 |
| Treatment with DHA/PPQ | 15/20 (75.0) | 8/12 (75.0) | 7/8 (87.5) | 0.60 | 4/4 (100.0) | 3/4 (75.0) | 1.0 |
| Parasitemia† | 0.4 (0.2–1.1) | 0.3 (0.1–0.9) | 0.9 (0.4–1.4) | 0.12 | 1.15 (0.4–1.9) | 0.8 (0.2–1.1) | 0.40 |
| Hb d0‡ |
12.5
(11.1–14.0) |
11.3
(10.5–13.5) |
13.1
(12.5–14.1) |
0.11 |
12.7
(12.4–13.8) |
13.7
(12.6–14.6) |
0.30 |
| Laboratory follow-up‡ | |||||||
| Hb d3 | 12.2 (10.6–13.6) | 11.1 (9.7–12.7) | 13.2 (12.2–14.3) | 0.02 | 12.8 (11.9–13.4) | 14.2 (12.5–14.6) | 0.15 |
| Hb d7 | 12.1 (11.1–13.0) | 11.7 (10.5–12.5) | 12.5 (11.9–12.6) | 0.33 | 12.6 (11.8–13.1) | 12.7 (11.5–12.9) | 0.66 |
| Hb d14 | 12.0 (10.9–12.6) | 11.7 (10.5–12.6) | 12.2 (11.9–12.6) | 0.33 | 12.5 (12.2–12.8) | 11.9 (10.5–12.5) | 0.11 |
| ΔHb d0–d3 | −0.4 (−0.8 to 0.0) | −0.5 (−1.0 to −0.3) | −0.1 (−0.6 to 0.6) | 0.07 | −0.4 (−1.1 to 0.7) | 0.1 (−0.2 to 0.6) | 0.40 |
| ΔHb d3–d7 | 0.0 (−0.8 to 0.5) | 0.3 (0.3–0.8) | −0.8 (−1.5 to −0.1) | 0.007 | −0.3 (−0.6 to 0.2) | −1.5 (−1.7 to −1.0) | NA |
| ΔHb d7–d14 | 0.1 (−0.5 to 0.5) | 0.3 (0.1–0.5) | −0.4 (−0.9 to 0.1) | 0.04 | 0.0 (−0.4 to 0.4) | −0.8 (−1.2 to −0.3) | NA |
| ΔHb d3–d14 | 0.0 (−0.7 to 0.5) | 0.3 (−0.1 to 0.7) | −1.3 (−2.0 to −0.3) | 0.002 | −0.3 (−0.6 to 0.3) | −1.9 (−2.6 to −1.9) | NA |
| ΔHb d0–d14 | −0.7 (−1.1 to 0.1) | −0.4 (−0.8 to 0.4) | −1.3 (−2.1 to −0.3) | 0.03 | −0.4 (−1.3 to 0.2) | −1.9 (−2.8 to −1.3) | NA |
| LDH d7, U/L | 250 (225–331) | 244 (222–274) | 327 (229–407) | 0.16 | 329 (211–495) | 327 (248–381) | 0.77 |
| LDH d14, U/L | 256 (210–283) | 210 (197–247) | 280 (256–365) | 0.006 | 273 (255–394) | 298 (234–365) | 1.0 |
| RPI d3 | 0.5 (0.3–0.7) | 0.4 (0.2–0.7) | 0.7 (0.4–0.7) | 0.22 | 0.7 (0.4–0.7) | 0.6 (0.5–0.7) | 1.0 |
| RPI d7 | 1.4 (0.9–1.6) | 1.4 (0.9–1.5) | 1.3 (0.8–2.0) | 0.66 | 1.7 (1.2–2.7) | 1.0 (0.4–1.8) | 0.24 |
| RPI d14 | 1.4 (1.0–1.8) | 1.1 (1.0–1.6) | 1.9 (1.4–2.6) | 0.015 | 2.5 (1.9–2.9) | 1.5 (1.1–1.9) | 0.04 |
*Values are median (interquartile range) or n/N (%). ACT, artemisinin-based combination therapy; ARM, artemether; d, day; Δ, period between indicated days; DHA, dihydroartemisinin; Hb, hemoglobin; LDH, lactate dehydrogenase; LUM, lumefantrine; NA, not applicable; PPQ, piperaquine; RPI, reticulocyte production index.
†Percentage of erythrocytes infected.
‡Hb levels are in grams/deciliter.
Page created: July 15, 2016
Page updated: July 15, 2016
Page reviewed: July 15, 2016
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.
Content Credential