Delayed-onset hemolytic anemia in patients with travel-associated severe malaria treated with artesunate, France, 2011-2013.

Abstract

Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.

• Authors: Stéphane Jauréguiberry, 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, French Artesunate Working Group
• Journal: Emerging infectious diseases (Emerg Infect Dis) Vol. 21 Issue 5 Pg. 804-12 (May 2015) ISSN: 1080-6059 [Electronic] United States
• PMID: 25898007 (Publication Type: Historical Article, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antimalarials
• Artemisinins
• Artesunate

Topics

• Adolescent
• Anemia, Hemolytic (epidemiology, etiology, history, mortality, therapy)
• Antimalarials (adverse effects, therapeutic use)
• Artemisinins (adverse effects, therapeutic use)
• Artesunate
• Blood Transfusion
• Female
• France (epidemiology)
• History, 21st Century
• Humans
• Malaria (complications, drug therapy, mortality, transmission)
• Male
• Travel
• Treatment Outcome