[Parenteral combined quinine-artesunate therapy in life-threatening malaria].
METHODS
A 31-year old French woman of congolese origin was referred to the intensive care unit of our University Hospital after a visit to the Democratic Republic of Congo in a highly febrile and semi-conscious status.


METHODS
Microscopy of stained thin and thick blood films revealed Plasmodium falciparum trophzoites with a high parasitaemia of 50 % and confirmed the clinical suspicion of a life-threatening malaria.


METHODS
Immediate intravenous quinine with a loading dose of 20 mg/kg body weight was initiated followed by 10 mg/kg every 8 hrs. Since the patient lost consciousness, artesunate was added six hours later in the recommended dose of 2.4 mg/kg immediately, repeated after 12 and 24 hrs, followed by a daily dose of 2.4 mg/kg. Furthermore, clindamycin at a dose of 20 mg/kg body weight / d i. v. was given. Anaemia was corrected by 4 erythrocyte concentrates until a haemoglobina concentration of 9.6 g/dl was reached. Now the patient rapidly recovered, and parasitaemia dropped to 0.1 % within 24 hrs. Already the following day blood films cleared completely from malaria parasites.


CONCLUSIONS
The case illustrates the rapid efficacy of a combined parenteral quinine-artesunate therapy in life-threatening falciparum malaria with an unusually high parasitaemia.
Richter
J
J
Klinik für Gastroenterologie, Hepatologie und Infektiologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf. Joachim.Richter@med.uni-duesseldorf.de
Abbasi-Boroudjeni
N
N
Koch
S
S
Müller-Stöver
I
I
Häussinger
D
D
D000328:Adult; D000740:Anemia / Q000150:complications / Q000628:therapy; D000962:Antimalarials / Q000008:administration & dosage / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral / Q000379:methods*; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000473:pathology; D011803:Quinine / Q000627:therapeutic use*; D016896:Treatment Outcome
D000962:Antimalarials; D037621:Artemisinins; D002981:Clindamycin; D000077332:Artesunate; D011803:Quinine