Successful treatment of imported cerebral malaria with artesunate-mefloquine combination therapy.
Treatment of cerebral malaria with intravenous quinine is frequently associated with life-threatening cardiotoxicity. We report a case of imported cerebral malaria successfully treated with artesunate-mefloquine combination therapy. The 27-year-old woman presented with fever, sudden onset of binocular blindness and altered consciousness 10 days after a short stay in Indonesia. Hyperparasitemia with Plasmodium falciparum and P. vivax in more than 5% of red blood cells was demonstrated on peripheral blood smear. She was admitted to the intensive care unit due to shock, jaundice and acute renal failure. Because of a shortage of intravenous quinine, intravenous artesunate was given as an alternative. Her condition stabilized on the 3rd day of therapy, with resolution of fever and disappearance of parasitemia. Consolidation therapy with oral mefloquine and primaquine was then given to prevent recrudescence and relapse. The only adverse event associated with artesunate was transient reticulocytopenia, which resolved after discontinuation of therapy. Her vision completely recovered, along with renal and liver function.
Sun
Hsin-Yun
HY
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C.
Fang
Chi-Tai
CT
Wang
Jann-Tay
JT
Kuo
Ping-Hung
PH
Chen
Yee-Chun
YC
Chang
Shan-Chwen
SC
D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D000077332:Artesunate; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016779:Malaria, Cerebral / Q000188:drug therapy*; D015767:Mefloquine / Q000627:therapeutic use*; D012156:Reticulocytes / Q000187:drug effects; D012717:Sesquiterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D014195:Travel; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine