Teresa Aldámiz-Echevarría Lois1, Ana López-Polín2, Francesca F Norman3, Begoña Monge-Maillo4, Rogelio López-Vélez5, Jose A Perez-Molina6. 1. Microbiology and Infectious Diseases Service, Gregorio Marañon Hospital, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain. Electronic address: teresaldamiz@yahoo.es. 2. National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: ana.lopez-polin@salud.madrid.org. 3. National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: ffnorman@gmail.com. 4. National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: begomongem@gmail.com. 5. National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: rogelio.lopezvelez@salud.madrid.org. 6. National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Carretera de Colmenar Viejo kilómetro 9,1, 28034, Madrid, Spain. Electronic address: jperezm@salud.madrid.org.
Abstract
BACKGROUND: Post-artesunate delayed haemolysis is described as hemolytic anemia presenting days after malaria treatment in hyperparasitemic patients. Physiopathological mechanisms and clinical manifestations have not been thoroughly characterised. METHODS: We conducted a retrospective study of hospitalised malaria patients who received artemisinin derivatives from January 1, 2010 to December 31, 2015. RESULTS: 21 patients were included in the study: 11 travellers, 8 travellers visiting friends and relatives and 2 immigrants. Median age was 35.5 years (IQR: 25.7-44.8) and 11 were men. Eight patients received oral and 13 received intravenous (IV) artemisinin-based drugs. Follow-up after the malaria episode was available for 15 patients (12 with IV treatment). Four patients presented with delayed haemolysis 9-14 days after artesunate treatment; all had been admitted with severe malaria, were treated IV and had hyperparasitaemia (17%-33%). Other than hyperparasitaemia, no other factors were associated with artesunate haemolysis. Patients' outcomes were favourable and the only additional therapeutic measure needed was a blood transfusion. CONCLUSIONS: Delayed haemolysis is a frequent complication in hyperparasitemic malaria treated with IV artesunate. Follow-up is mandatory for at least 2 weeks after treatment initiation. This condition is potentially severe but does not appear to be life threatening.
BACKGROUND: Post-artesunatedelayed haemolysis is described as hemolytic anemia presenting days after malaria treatment in hyperparasitemic patients. Physiopathological mechanisms and clinical manifestations have not been thoroughly characterised. METHODS: We conducted a retrospective study of hospitalised malariapatients who received artemisinin derivatives from January 1, 2010 to December 31, 2015. RESULTS: 21 patients were included in the study: 11 travellers, 8 travellers visiting friends and relatives and 2 immigrants. Median age was 35.5 years (IQR: 25.7-44.8) and 11 were men. Eight patients received oral and 13 received intravenous (IV) artemisinin-based drugs. Follow-up after the malaria episode was available for 15 patients (12 with IV treatment). Four patients presented with delayed haemolysis 9-14 days after artesunate treatment; all had been admitted with severe malaria, were treated IV and had hyperparasitaemia (17%-33%). Other than hyperparasitaemia, no other factors were associated with artesunatehaemolysis. Patients' outcomes were favourable and the only additional therapeutic measure needed was a blood transfusion. CONCLUSIONS:Delayed haemolysis is a frequent complication in hyperparasitemic malaria treated with IV artesunate. Follow-up is mandatory for at least 2 weeks after treatment initiation. This condition is potentially severe but does not appear to be life threatening.
Authors: H Hilda Ampadu; Alexander N O Dodoo; Samuel Bosomprah; Samantha Akakpo; Pierre Hugo; Helga Gardarsdottir; H G M Leufkens; Dan Kajungu; Kwaku Poku Asante Journal: Drug Saf Date: 2018-09 Impact factor: 5.606
Authors: Marion Louvois; Loïc Simon; Christelle Pomares; Pierre-Yves Jeandel; Elisa Demonchy; Michel Carles; Pascal Delaunay; Johan Courjon Journal: Front Med (Lausanne) Date: 2022-01-17