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Abstract :
[en] Intravenous artesunate is the treatment of choice for severe and complicated malaria according to the WHO 2010 guidelines. Seventeencases of delayed hemolysis after parenteral treatment with artesunate have been recently reported in European travellers with imported Plasmodium falciparummalaria1.
We report the case of a 40-years-old Belgian man who contracted severe falciparum malaria after a four-weeks stay in Central and Eastern Africa without taking any antimalarial chemoprophylaxis.
He presented on admission with fever, headache, jaundice andabdominal syndrome.Thereafter hisbiological and clinical conditionrapidly worsened withconsciousness disorders, severe thrombocytopenia,acute hepatitis and pancreatitis, and renal failure. Parasitemia reached a peak of 37 % on the second day of admission.
Since this patient fulfilled WHO 2010 criteria for severe malaria,intravenous artesunatetreatment dosed at 2,4 mg/kg was started. Parasite clearancewas obtained after 48 hours and the patient’s clinical status improved significantly.Five doses of intravenous artesunate were administered, followed by oral artemeter/lumefantrine treatment during 60 hours.
Tendays after the first dose of artesunate the patient developed a severe hemolyticanemia(hemoglobin4,9 g/dL) associated with impaired renal function. Thick blood film was negative. Blood transfusion and high doses of corticosteroids were successfully administrated and hemodialysis was not necessary.
Until now, no clear explanation has been given to this complication. This case highlights the usefulness of extended follow-up including haematological parametersforpatients treated with artesunate, at least one monthafter the malaria episode.
1Published reports of delayed hemolyticanemia after treatment with artesunate for severe malaria--worldwide, 2010-2012. Centers for Disease Control and Prevention (CDC).
