title: Delayed-onset hemolytic anemia in patients with travel-associated severe malaria treated with artesunate, France, 2011-2013.
abstract: Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Jauréguiberry
authors.forename: Marc
authors.initials: M
authors.lastname: Thellier
authors.forename: Papa Alioune
authors.initials: PA
authors.lastname: Ndour
authors.forename: Flavie
authors.initials: F
authors.lastname: Ader
authors.forename: Camille
authors.initials: C
authors.lastname: Roussel
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
authors.forename: Adela
authors.initials: A
authors.lastname: Angoulvant
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wyplosz
authors.forename: Christophe
authors.initials: C
authors.lastname: Rapp
authors.forename: Thierry
authors.initials: T
authors.lastname: Pistone
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Lebrun-Vignes
authors.forename: Eric
authors.initials: E
authors.lastname: Kendjo
authors.forename: Martin
authors.initials: M
authors.lastname: Danis
authors.forename: Sandrine
authors.initials: S
authors.lastname: Houzé
authors.forename: François
authors.initials: F
authors.lastname: Bricaire
authors.forename: Dominique
authors.initials: D
authors.lastname: Mazier
authors.forename: Pierre
authors.initials: P
authors.lastname: Buffet
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
mesh_terms: D000293:Adolescent; D000743:Anemia, Hemolytic / Q000453:epidemiology* / Q000209:etiology* / Q000266:history / Q000401:mortality / Q000628:therapy; D000962:Antimalarials / Q000009:adverse effects* / Q000627:therapeutic use; D037621:Artemisinins / Q000009:adverse effects* / Q000627:therapeutic use; D000077332:Artesunate; D001803:Blood Transfusion; D005260:Female; D005602:France / Q000453:epidemiology; D049674:History, 21st Century; D006801:Humans; D008288:Malaria / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000635:transmission*; D008297:Male; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate
keywords: France; Plasmodium falciparum; artesunate; delayed-onset; hemolysis; hemolytic anemia; imported; incidence; malaria; outcome; parasites; safety; therapeutic benefit; travel-associated; travelers; vector-borne infections