title: Successful treatment of imported cerebral malaria with artesunate-mefloquine combination therapy.
abstract: 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.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, and National Taiwan University College of Medicine, Taipei, Taiwan, R.O.C.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Fang
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Ping-Hung
authors.initials: PH
authors.lastname: Kuo
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: 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
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D015767:Mefloquine