title: Severe malaria in Europe: an 8-year multi-centre observational study.
abstract: Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria.
  
  
  
  The European Network for Tropical Medicine and Travel Health (TropNet) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria.
  
  
  
  From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections were acquired in West Africa (109/185, 59%). The proportion of patients treated with intravenous artesunate increased from 27% in 2006 to 60% in 2013. Altogether, 56 different combinations of intravenous and oral drugs were used across 28 study centres. The risk of acute renal failure (36 vs 17% p = 0.04) or cerebral malaria (54 vs 20%, p = 0.001) was significantly higher in patients ≥60 years than in younger patients. Respiratory distress with the need for mechanical ventilation was significantly associated with the risk of death in the study population (13 vs 0%, p = 0.001). Post-artemisinin delayed haemolysis was reported in 19/70 (27%) patients treated with intravenous artesunate.
  
  
  
  The majority of patients with severe malaria in this study were tourists or migrants acquiring the infection in West Africa. Intravenous artesunate is increasingly used for treatment of severe malaria in many European treatment centres and can be given safely to European patients with severe malaria. Patients treated with intravenous artesunate should be followed up to detect and manage late haemolytic events.
authors.affiliation: Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kurth
authors.affiliation: Hôpital Saint-Antoine, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Develoux
authors.affiliation: Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Mechain
authors.affiliation: Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Malvy
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Clerinx
authors.affiliation: Department of Biomedical and Clinical Sciences L.Sacco, University of Milano, Milan, Italy.
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
authors.affiliation: Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark.
authors.forename: Ida E
authors.initials: IE
authors.lastname: Gjørup
authors.affiliation: ISGlobal, Barcelona Center for International Health Research. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Joaquím
authors.initials: J
authors.lastname: Gascon
authors.affiliation: Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Mørch
authors.affiliation: National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.affiliation: Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.|Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Ramharter
authors.affiliation: SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Visser
authors.affiliation: Section Tropical Medicine, Department of Internal Medicine I, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Department of Clinical Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
authors.forename: Thierry
authors.initials: T
authors.lastname: Rolling
authors.affiliation: Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.|Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Zanger
authors.affiliation: Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Calleri
authors.affiliation: Tropical Medicine Unit, Hospital de Poniente, El Ejido, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Salas-Coronas
authors.affiliation: Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.affiliation: Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Just-Nübling
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Neumayr
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Hachfeld
authors.affiliation: Department of Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: Matthias L
authors.initials: ML
authors.lastname: Schmid
authors.affiliation: Clinica Luganese, Lugano, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Antonini
authors.affiliation: Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Lingscheid
authors.affiliation: Comprehensive Infectious Diseases Center, Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kern
authors.affiliation: Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Kapaun
authors.affiliation: Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: José Saraiva
authors.initials: JS
authors.lastname: da Cunha
authors.affiliation: Division of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Pongratz
authors.affiliation: Hospital Universitari Joan XXIII, Tarragona, Spain.|Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Soriano-Arandes
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Schunk
authors.affiliation: Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hatz
authors.affiliation: Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany. thomas.zoller@unibas.ch.|Swiss Tropical and Public Health Institute, Basel, Switzerland. thomas.zoller@unibas.ch.|University of Basel, Basel, Switzerland. thomas.zoller@unibas.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zoller
mesh_terms: D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000145:classification / Q000627:therapeutic use*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000962:Antimalarials
keywords: Artesunate; Clinical study; Europe; Falciparum; Malaria; Plasmodium; Quinine; Severe malaria