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Malar J. 2017 Jan 31;16(1):57. doi: 10.1186/s12936-016-1673-z.

Severe malaria in Europe: an 8-year multi-centre observational study.

Author information

1
Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
2
Hôpital Saint-Antoine, Paris, France.
3
Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France.
4
Institute of Tropical Medicine, Antwerp, Belgium.
5
Department of Biomedical and Clinical Sciences L.Sacco, University of Milano, Milan, Italy.
6
Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark.
7
ISGlobal, Barcelona Center for International Health Research. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
8
Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.
9
Department of Clinical Science, University of Bergen, Bergen, Norway.
10
National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
11
Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
12
Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
13
SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
14
Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
15
Section Tropical Medicine, Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
16
Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
17
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
18
Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy.
19
Tropical Medicine Unit, Hospital de Poniente, El Ejido, Spain.
20
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
21
Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany.
22
Swiss Tropical and Public Health Institute, Basel, Switzerland.
23
University of Basel, Basel, Switzerland.
24
Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
25
Department of Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
26
Clinica Luganese, Lugano, Switzerland.
27
Comprehensive Infectious Diseases Center, Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany.
28
Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany.
29
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
30
Division of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany.
31
Hospital Universitari Joan XXIII, Tarragona, Spain.
32
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
33
Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
34
Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany. thomas.zoller@unibas.ch.
35
Swiss Tropical and Public Health Institute, Basel, Switzerland. thomas.zoller@unibas.ch.
36
University of Basel, Basel, Switzerland. thomas.zoller@unibas.ch.

Abstract

BACKGROUND:

Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria.

METHODS:

The European Network for Tropical Medicine and Travel Health (TropNet) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria.

RESULTS:

From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections were acquired in West Africa (109/185, 59%). The proportion of patients treated with intravenous artesunate increased from 27% in 2006 to 60% in 2013. Altogether, 56 different combinations of intravenous and oral drugs were used across 28 study centres. The risk of acute renal failure (36 vs 17% p = 0.04) or cerebral malaria (54 vs 20%, p = 0.001) was significantly higher in patients ≥60 years than in younger patients. Respiratory distress with the need for mechanical ventilation was significantly associated with the risk of death in the study population (13 vs 0%, p = 0.001). Post-artemisinin delayed haemolysis was reported in 19/70 (27%) patients treated with intravenous artesunate.

CONCLUSION:

The majority of patients with severe malaria in this study were tourists or migrants acquiring the infection in West Africa. Intravenous artesunate is increasingly used for treatment of severe malaria in many European treatment centres and can be given safely to European patients with severe malaria. Patients treated with intravenous artesunate should be followed up to detect and manage late haemolytic events.

KEYWORDS:

Artesunate; Clinical study; Europe; Falciparum; Malaria; Plasmodium; Quinine; Severe malaria

PMID:
28143519
PMCID:
PMC5286792
DOI:
10.1186/s12936-016-1673-z
[Indexed for MEDLINE]
Free PMC Article

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