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J Infect Dis. 2014 Jun 15;209(12):1921-8. doi: 10.1093/infdis/jit841. Epub 2013 Dec 26.

Delayed hemolysis after treatment with parenteral artesunate in African children with severe malaria--a double-center prospective study.

Author information

1
Department of Internal Medicine I, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany Centre de Recherches Médicales de Lambaréné, Gabon.
2
School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
3
Centre de Recherches Médicales de Lambaréné, Gabon Institute of Tropical Medicine, University Medical Center Tübingen, Tübingen, Germany.
4
School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Paediatric Emergency Unit, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
5
Department of Internal Medicine I, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
6
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
7
Centre de Recherches Médicales de Lambaréné, Gabon Institute of Tropical Medicine, University Medical Center Tübingen, Tübingen, Germany Centre for Infection and Immunity, Division of Clinical Sciences, St. George's, University of London, London, United Kingdom.

Abstract

BACKGROUND:

Parenteral artesunate is recommended as first-line therapy for severe malaria. While its efficacy is firmly established, data on safety are still incomplete. Delayed hemolysis has been described in hyperparasitemic nonimmune travelers, but it is unknown if African children are equally at risk.

METHODS:

Children aged 6 to 120 months with severe malaria were followed up after treatment with parenteral artesunate in Lambaréné, Gabon, and Kumasi, Ghana. The primary outcome was incidence of delayed hemolysis on day 14.

RESULTS:

In total, 72 children contributed complete data sets necessary for primary outcome assessment. Delayed hemolysis was detected in 5 children (7%), with 1 child reaching a nadir in hemoglobin of 2.8 g/dL. Patients with delayed hemolysis had higher parasite counts on admission (geometric mean parasite densities (GMPD) 306 968/µL vs 92 642/µL, P = .028) and were younger (median age: 24 months vs 43 months, P = .046) than the rest of the cohort. No correlation with sickle cell trait or glucose-6-phosphate-dehydrogenase deficiency was observed.

CONCLUSIONS:

Delayed hemolysis is a frequent and relevant complication in hyperparasitemic African children treated with parenteral artesunate for severe malaria. Physicians should be aware of this complication and consider prolonged follow-up.

CLINICAL TRIALS REGISTRATION:

Pan-African Clinical Trials Registry: PACTR201102000277177 (www.pactr.org).

KEYWORDS:

African children; Severe malaria; adverse events; artesunate; hemolysis

PMID:
24376273
DOI:
10.1093/infdis/jit841
[Indexed for MEDLINE]

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