Severe
falciparum malaria is a medical emergency that is associated with a high rate of mortality, even when treated in an Intensive Care Unit. Until recently, intravenous
quinine was the standard treatment; however,
artemisin derivatives are now regarded as the first-line treatment for multidrug-resistant
falciparum malaria. Although several studies have demonstrated the superiority of
Artesunate, this
drug is not licensed in many countries. This article describes the case of an HIV-positive patient, who returned from Africa and presented with 10%
parasitemia and clinical signs of severe
falciparum malaria; this individual was successfully treated with a combination of
artesunate and
quinine.
Artesunate was imported from the foreign market, and written consent for its administration was obtained in advance. Parasite clearance was rapidly achieved; however, on day IV, the patient developed
acute respiratory distress syndrome that required
mechanical ventilation. The patient was extubated on day XIV and discharged on day XXV. Due to its rapid action,
artesunate was likely responsible for the good clinical outcome in this case; however, in order to clarify the role of this new combination
therapy, further studies are required.