gms | German Medical Science

10th Malaria Meeting

Working party Malaria / Section Antiparasitic Chemotherapy of the Paul-Ehrlich-Society (PEG e.V.) in cooperation with the German Society for Tropical Medicine and International Health (DTG e.V.) and the German Society for Parasitology (DGP e.V.)

09.11. - 10.11.2012, Marburg an der Lahn

Post-treatment anaemia in African children with severe malaria after treatment with parenteral artesunate – a prospective observational study

Meeting Abstract

  • T. Rolling - I.Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, University Medical Centre Hamburg-Eppendorf, Germany; Bernhard-Nocht-Institute for Tropcial Medicine, Section Clinical Research, Hamburg, Germany
  • D. Spahlinger - I.Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, University Medical Centre Hamburg-Eppendorf, Germany; Bernhard-Nocht-Institute for Tropcial Medicine, Section Clinical Research, Hamburg, Germany
  • T. Agbenyega - Kwame Nkrumah University of Science and Technology, School of Medicine, Kumasi, Ghana
  • S. Issifou - Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
  • S. Bolte - Institute of Tropical Medicine, Tübingen, Germany
  • P. G. Kremsner - Institute of Tropical Medicine, Tübingen, Germany
  • G. D. Burchard - I.Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, University Medical Centre Hamburg-Eppendorf, Germany; Bernhard-Nocht-Institute for Tropcial Medicine, Section Clinical Research, Hamburg, Germany
  • B. Mordmüller - Institute of Tropical Medicine, Tübingen, Germany
  • J. P. Cramer - I.Department of Internal Medicine, Division of Tropical Medicine and Infectious Diseases, University Medical Centre Hamburg-Eppendorf, Germany; Bernhard-Nocht-Institute for Tropcial Medicine, Section Clinical Research, Hamburg, Germany

10th Malaria Meeting. Marburg, 09.-10.11.2012. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc12mal10

doi: 10.3205/12mal10, urn:nbn:de:0183-12mal101

Published: January 8, 2013

© 2013 Rolling et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: Parenteral artesunate is now considered to be the first-line treatment for severe malaria because of its superiority when compared to parenteral quinine. However data on medium to long-term side effects of parenteral artesunate are scarce so far. As parenteral artesunate has been implemented as the treatment of choice for imported severe malaria in a growing number of centres in Europe, first reports have revealed cases of post-treatment haemolysis in a significant proportion of patients. Whether this potential side-effect is also clinically relevant in African children is unknown. We therefore designed a prospective observational study to detect any haematological alterations after parenteral artesunate in the endemic setting of Sub-Saharan Africa.

Methods: Children in Lambaréné, Gabon and Kumasi, Ghana between the age of six months and ten years were eligible for inclusion if they presented with Plasmodium falciparum malaria warranting hospitalization. Patients were treated with a total of 12 mg/kg body weight of parenteral artesunate. Clinical parameters and blood samples were obtained at presentation (day 0) and at follow-up visits on days 7 (±2), 14 (±3) and 28 (±4).

Results: A total of 102 patients were recruited. 31% of children experienced a decrease in haemoglobin (Hb) larger than 0.5 g/dl between days 0 and 14, while the mean rise in Hb for all children was 1.2 g/dl. 28 children received a blood transfusion at some point during hospitalization, thereby influencing the haemoglobin levels. 42% of children who did not receive any blood transfusion had a decrease of at least 0.5 g/dl between days 0 and 14, while the mean decrease in this group was 0.1 g/dl. When controlling for baseline Hb, the difference in Hb between day 0 and day 14 negatively correlates with geometric mean parasite density.

Conclusion: A significant proportion of African children treated with artesunate have not recovered from their malaria-induced anaemia two weeks after treatment has been initiated. Hyperparasitaemita seems to be a relevant risk factor for not recovering from anaemia. In how far this effect is due to haemolysis or impaired erythropoiesis has to be determined in our subsequent analyses.