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Leblanc C, Vasse C, Minodier P, Mornand P, Naudin J, Quinet B, Siriez JY, Sorge F, de Suremain N, Thellier M, Kendjo E, Faye A, Imbert P. Management and prevention of imported malaria in children. Update of the French guidelines. Med Mal Infect 2019; 50:127-140. [PMID: 30885541 DOI: 10.1016/j.medmal.2019.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 02/18/2019] [Indexed: 01/09/2023]
Abstract
Since the 2007 French guidelines on imported Falciparum malaria, the epidemiology, treatment, and prevention of malaria have changed considerably requiring guidelines for all Plasmodium species to be updated. Over the past decade, the incidence of imported malaria has decreased in all age groups, reflecting the decrease in the incidence of malaria in endemic areas. The rates of severe pediatric cases have increased as in adults, but fatalities are rare. The parasitological diagnosis requires a thick blood smear (or a rapid immunochromatographic test) and a thin blood film. Alternatively, a rapid antigen detection test can be paired with a thin blood film. Thrombocytopenia in children presenting with fever is highly predictive of malaria following travel to a malaria-endemic area and, when detected, malaria should be strongly considered. The first-line treatment of uncomplicated P. falciparum malaria is now an artemisinin-based combination therapy (ACT), either artemether-lumefantrine or artenimol-piperaquine, as recommended by the World Health Organization in endemic areas. Uncomplicated presentations of non-falciparum malaria should be treated either with chloroquine or ACT. The first-line treatment of severe malaria is now intravenous artesunate which is more effective than quinine in endemic areas. Quinine is restricted to cases where artesunate is contraindicated or unavailable. Prevention of malaria in pediatric travelers consists of nocturnal personal protection against mosquitoes (especially insecticide-treated nets) combined with chemoprophylaxis according to the risk level.
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Affiliation(s)
- C Leblanc
- Pédiatrie générale et maladies infectieuses, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - C Vasse
- Accueil des urgences pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Minodier
- Urgences enfants, CHU Nord, chemin des Bourrely, 13015 Marseille, France; Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Mornand
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - J Naudin
- Réanimation pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - B Quinet
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - J Y Siriez
- Accueil des urgences pédiatriques, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - F Sorge
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie générale, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - N de Suremain
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Service de pédiatrie et aval des urgences, hôpital d'Enfants A. Trousseau, 26, avenue du docteur Arnold-Netter, 75012 Paris, France
| | - M Thellier
- Centre national de référence du paludisme, service de parasitologie-mycologie, hôpital Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France
| | - E Kendjo
- Centre national de référence du paludisme, service de parasitologie-mycologie, hôpital Pitié-Salpêtrière, 43-87, boulevard de l'Hôpital, 75013 Paris, France
| | - A Faye
- Pédiatrie générale et maladies infectieuses, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - P Imbert
- Groupe de pédiatrie tropicale de la Société française de pédiatrie, pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre de vaccinations internationales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Abstract
BACKGROUND Children with uncomplicated Plasmodium falciparum imported malaria are treated with various antimalarial regimens including mefloquine depending on national guidelines. Little is known regarding mefloquine treatment efficacy in this setting. METHODS In this prospective study, children 3 months to 16 years of age admitted in a tertiary hospital emergency ward in France with uncomplicated P. falciparum malaria were treated with oral mefloquine. Each dose was given with an antiemetic. RESULTS Between 2004 and 2009, 95 children were evaluated. In all, 94% had traveled in the Indian Ocean region (Comoros and Madagascar); 79% used a malaria chemoprophylaxis, but none was fully compliant with World Health Organization recommended regimens. Main clinical features at admission were fever (91%), vomiting (44%), and headaches (44%). Hemoglobin < 80 g/L and platelets <100 G/L were observed in 16% and 17%, respectively. All children were initially cured by mefloquine, and no relapse was noted within 45 days after admission. One Plasmodium vivax relapse occurred 6 months later. Vomiting within 1 hour after dosing occurred in 20% of children. Significant features associated with early vomiting by univariate analysis were a weight ≤ 15 kg, C-reactive protein ≥ 50 mg/L, and parasitemia ≥ 1%, but only low weight was significant by multivariate analysis. CONCLUSION Mefloquine is an effective treatment for uncomplicated imported P. falciparum malaria in children returning from countries with low mefloquine resistance. Early vomiting after mefloquine dosing is frequent, especially in children < 15 kg of weight, but a second dose can be given successfully.
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Frey SG, Chelo D, Kinkela MN, Djoukoue F, Tietche F, Hatz C, Weber P. Artesunate-mefloquine combination therapy in acute Plasmodium falciparum malaria in young children: a field study regarding neurological and neuropsychiatric safety. Malar J 2010; 9:291. [PMID: 20964849 PMCID: PMC2984569 DOI: 10.1186/1475-2875-9-291] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/21/2010] [Indexed: 11/16/2022] Open
Abstract
Background Mefloquine-artesunate combination therapy for uncomplicated falciparum malaria is one of the treatments used in African children. Data concerning neurological safety in adults and children treated with mefloquine and artesunate combination therapy is well documented in Asia. Safety data for neurological and neuropsychiatric side effects of mefloquine and artesunate combination therapy in African children are scarce, although WHO recommends this therapy in Africa. Methods A phase IV, open label, single arm study was conducted among African children between 10 and 20 kg with acute uncomplicated falciparum malaria. They were treated over three consecutive days with a paediatric fixed-dose combination of artesunate (50 mg/d) and mefloquine (125 mg/d). Parasitological, clinical and neurological examinations and standardized questions about neuropsychiatric symptoms were carried out on days 0, 4, 7, 28 and 63. The primary objective was to assess the neurological and neuropsychiatric safety of artesunate-mefloquine combination therapy in young children. Results From December 2007 to March 2009, 220 children with uncomplicated Plasmodium falciparum malaria were treated with artesunate and mefloquine. 213 children were analysed according to study protocol. 50 neurological and neuropsychiatric adverse events occurred in 28 patients. Eleven drug-related neurological and neuropsychiatric adverse events occurred in eight patients. Sleeping disorders were present in 2.3%, neurological disorders in 1.4%, neuropsychiatric disorders in 1% and eating disorders in 0.5% of the patients. Adverse events were of mild to moderate intensity and resolved spontaneously. Conclusion African children showed a low percentage of self-limited neurological and neuropsychiatric adverse events, confirming studies on neurological safety in Asian children treated with artesunate and mefloquine. Sleeping disorders were most frequently observed.
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Affiliation(s)
- Sarabel G Frey
- Division of Neuropaediatrics and Developmental Medicine, University Children's Hospital Basel, Switzerland.
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