期刊
JOURNAL OF INFECTIOUS DISEASES
卷 209, 期 12, 页码 1921-1928出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jit841
关键词
Severe malaria; artesunate; adverse events; hemolysis; African children
资金
- European & Developing Countries Clinical Trials Partnership (EDCTP) [CT.2004.31070.001]
- German Ministry for Education and Research (Bundesministerium fur Bildung und Forschung, BMBF) [01KA1011]
- Werner-Otto-Stiftung Hamburg [7/81]
- BMBF via the German Centre for Infection Research (Deutsches Zentrum fur Infektionsforschung, DZIF) [8000-202-2]
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 Lambarene, 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/mu L vs 92 642/mu L, 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.
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