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Alsolami E. Intravenous Artesunate Treatment of Severe Malaria in a Patient With Systemic Lupus Erythematosus: A Case of Post-Artesunate Delayed Hemolysis. Cureus 2023; 15:e44201. [PMID: 37767260 PMCID: PMC10521586 DOI: 10.7759/cureus.44201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune condition linked to multi-organ damage, and its correlation with malaria has been theorized. This case report details a 14-year-old Sudanese girl diagnosed with SLE and severe malaria who experienced hemolytic anemia following intravenous artesunate treatment. Intravenous artesunate was administered as the recommended treatment for severe malaria for one week and led to prolonged hemolysis with low hemoglobin levels and elevated lactate dehydrogenase activity; over three weeks, the hemolysis gradually subsided. This case highlights the need to consider post-artesunate (or artemisinin) delayed hemolysis (PADH) as a potential complication among patients receiving artemisinin derivatives for malaria treatment, thus necessitating enhanced surveillance strategies and further investigation of its mechanisms to optimize clinical practice and patient outcomes in this population.
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Affiliation(s)
- Enad Alsolami
- Internal Medicine, College of Medicine, University of Jeddah, Jeddah, SAU
- Internal Medicine, Saudi German Hospital, Jeddah, SAU
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2
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Louvois M, Simon L, Pomares C, Jeandel PY, Demonchy E, Carles M, Delaunay P, Courjon J. Case Report: Autoimmune Hemolysis Anemia After Dihydroartemisinin and Piperaquine for Uncomplicated Plasmodium falciparum Malaria. Front Med (Lausanne) 2022; 8:756050. [PMID: 35111773 PMCID: PMC8801417 DOI: 10.3389/fmed.2021.756050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Malaria is still an endemic disease in Africa, with many imported cases in Europe. The standard treatment is intravenous artesunate for severe malaria and oral artemisinin-based combination therapy (ACT) for uncomplicated malaria. Delayed hemolytic anemia (DHA) after intravenous artesunate has been extensively described, and guidelines recommend biological monitoring until 1 month after the end of the treatment. A link with an autoimmune process is still unsure. Nevertheless, cases with positive direct antiglobulin test (DAT) have been reported. Conversely, DHA is not recognized as an adverse effect of oral ACT. Previously, only few cases of DHA occurring after oral ACT without intravenous artesunate administration have been reported. We report the case of a 42-year-old man returning from Togo. He was treated with dihydroartemisinin/piperaquine combination for uncomplicated Plasmodium falciparum malaria, with low parasitemia. Nine days after the end of the treatment, the patient developed hemolytic anemia with positive DAT. Eventually, the patient recovered after corticotherapy. After excluding common causes of autoimmune hemolytic anemia, we considered that dihydroartemisinin/piperaquine treatment was involved in this side effect.
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Affiliation(s)
- Marion Louvois
- Rheumatology, Université Côte d'Azur, CHU Nice, Nice, France
| | - Loïc Simon
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Christelle Pomares
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | | | - Elisa Demonchy
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Michel Carles
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
| | - Pascal Delaunay
- Parasitology and Mycology Department, Université Côte d'Azur, CHU Nice, Nice, France
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
| | - Johan Courjon
- Université Côte d'Azur, INSERM 1065, C3M, Nice, France
- Infectious Diseases Department, Université Côte d'Azur, CHU Nice, Nice, France
- *Correspondence: Johan Courjon
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3
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Ascoli Bartoli T, Lepore L, D'Abramo A, Adamo G, Corpolongo A, Scorzolini L, Giancola ML, Bevilacqua N, Palazzolo C, Mariano A, Ippolito G, Buffet P, Nicastri E. Systematic analysis of direct antiglobulin test results in post-artesunate delayed haemolysis. Malar J 2021; 20:206. [PMID: 33926462 PMCID: PMC8082776 DOI: 10.1186/s12936-021-03735-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Post-artesunate delayed haemolysis (PADH) is common after severe malaria episodes. PADH is related to the “pitting” phenomenon and the synchronous delayed clearance of once-infected erythrocytes, initially spared during treatment. However, direct antiglobulin test (DAT) positivity has been reported in several PADH cases, suggesting a contribution of immune-mediated erythrocyte clearance. The aim of the present study was to compare clinical features of cases presenting a positive or negative DAT. Methods Articles reporting clinical data of patients diagnosed with PADH, for whom DAT had been performed, were collected from PubMed database. Data retrieved from single patients were extracted and univariate analysis was performed in order to identify features potentially related to DAT results and steroids use. Results Twenty-two studies reporting 39 PADH cases were included: median baseline parasitaemia was 20.8% (IQR: 11.2–30) and DAT was positive in 17 cases (45.5%). Compared to DAT-negative individuals, DAT-positive patients were older (49.5 vs 31; p = 0.01), had a higher baseline parasitaemia (27% vs 17%; p = 0.03) and were more commonly treated with systemic steroids (11 vs 3 patients, p = 0.002). Depth and kinetics of delayed anaemia were not associated with DAT positivity. Conclusions In this case series, almost half of the patients affected by PADH had a positive DAT. An obvious difference between the clinical courses of patients presenting with a positive or negative DAT was lacking. This observation suggests that DAT result may not be indicative of a pathogenic role of anti-erythrocytes antibodies in patients affected by PADH, but it may be rather a marker of immune activation. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03735-w.
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Affiliation(s)
- Tommaso Ascoli Bartoli
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Luciana Lepore
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Alessandra D'Abramo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy.
| | - Giovanna Adamo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Angela Corpolongo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Laura Scorzolini
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Maria Letizia Giancola
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Nazario Bevilacqua
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Claudia Palazzolo
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Andrea Mariano
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Giuseppe Ippolito
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
| | - Pierre Buffet
- UMRS 1134, Inserm, Université de Paris, 75015, Paris, France.,Laboratory of Excellence GREx, 75015, Paris, France
| | - Emanuele Nicastri
- Lazzaro Spallanzani, National Institute for Infectious Diseases-IRCCS, Via Portuense, 292, Cap 00149, Rome, Italy
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Post-artemisinin delayed hemolysis after oral therapy for P. falciparum infection. IDCases 2020; 20:e00741. [PMID: 32195118 PMCID: PMC7076566 DOI: 10.1016/j.idcr.2020.e00741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
Post-artemisinin delayed hemolysis after oral artemisinin therapy. Hemolytic anemia requiring transfusion after severe malaria infection and oral artemether-lumefantrine. Oral artemisinin therapy can cause post-artemisinin delayed hemolysis without exposure to IV artesunate. Corticosteroid therapy may reduce blood transfusion burdens in post-artemisinin delayed hemolysis.
A documented side-effect of artemisinin therapy is post-artemisinin delayed hemolysis (PADH), primarily occurring after parenteral treatment for severe P. falciparum infections. PADH has been infrequently reported after oral therapy and is rarely severe enough to require hospitalization and blood transfusions. A 24 year old man was diagnosed with P. falciparum, prompting initiation of oral artemether-lumefantrine (AL). Further work-up demonstrated that he met WHO criteria for severe malaria infection on the basis of high parasitemia and his regimen was switched to intravenous quinidine and oral doxycycline. He was transitioned back to AL after 4 days and was discharged on hospital day six. Five days later, he was readmitted for hemolytic anemia. His peripheral blood was absent of malaria parasites and he was diagnosed with PADH, ultimately requiring multiple blood transfusions. Severe hemolytic anemia requiring blood transfusions after oral artemisinin therapy is rare and may be associated with higher parasite loads. This case demonstrates the importance of close reassessment and consideration of PADH in patients treated with oral therapies, particularly in the setting of severe malarial infections.
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Norman FF, Comeche B, Chamorro S, Pérez-Molina JA, López-Vélez R. Update on the major imported protozoan infections in travelers and migrants. Future Microbiol 2020; 15:213-225. [PMID: 32065535 DOI: 10.2217/fmb-2019-0212] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Globalization has contributed to the emergence of specific parasitic diseases in novel geographical areas, and in these regions, these infections in travelers and immigrants may cause a considerable burden of disease. Timely diagnosis and treatment of protozoan infections to decrease mortality and prevent associated complications are essential. In this respect, the increased availability of specific DNA-detection procedures has improved the diagnosis of many imported parasitic infections. Travelers and immigrants with associated comorbidities or immunosuppression may pose a special challenge regarding management. An updated review of the main protozoan infections in mobile populations (malaria, Chagas disease, leishmaniasis, enteric protozoan infections) is provided, focusing on the changing epidemiology of these diseases, recent developments in diagnosis and management and the possibility of local transmission of imported infections.
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Affiliation(s)
- Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Belén Comeche
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Sandra Chamorro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - José-Antonio Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Ctra Colmenar, Km 9,100, 28034, Madrid, Spain
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Savargaonkar D, Das MK, Verma A, Mitra JK, Yadav CP, Srivastava B, Anvikar AR, Valecha N. Delayed haemolysis after treatment with intravenous artesunate in patients with severe malaria in India. Malar J 2020; 19:39. [PMID: 31969146 PMCID: PMC6977313 DOI: 10.1186/s12936-020-3120-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Parenteral artesunate is the treatment of choice for severe malaria. It is safe, efficacious and well tolerated anti-malarial. However, delayed haemolysis has been reported in travellers, non-immune individuals and in African children. Methods A prospective, observational study was carried out in admitted severe malaria patients receiving parenteral artesunate. The patients were followed up until day 28 for monitoring clinical as well as laboratory parameters for haemolytic anaemia. Results Twenty-four patients with severe malaria receiving injection artesunate were enrolled in the study. Post-artesunate delayed haemolysis following parenteral artesunate therapy was observed in three of 24 patients (12.5%, 95% confidence interval 4.5–31.2%). Haemolysis was observed in two more patients possibly due to other reasons. The haemoglobin fall ranged from 13.6 to 38.3% from day 7 to day 28 in these patients. Conclusion The possibility of delayed haemolysis should be considered while treating the severe malaria patients with parenteral artesunate. The study highlights the need for further studies in different epidemiological settings.
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Affiliation(s)
- Deepali Savargaonkar
- National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India.
| | - Manoj Kumar Das
- National Institute of Malaria Research, Field Unit, Ranchi, Jharkhand, India
| | - Amar Verma
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Jeevan K Mitra
- Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - C P Yadav
- National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Bina Srivastava
- National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Anupkumar R Anvikar
- National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
| | - Neena Valecha
- National Institute of Malaria Research, Sector 8, Dwarka, New Delhi, 110077, India
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Hemolytic anemia in pediatric patients treated with artesunate for severe malaria. Enferm Infecc Microbiol Clin 2019; 38:139-140. [PMID: 31378562 DOI: 10.1016/j.eimc.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022]
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Salehi M, Masoumi-Asl H, Assarian M, Khoshnam-Rad N, Haghi AM, Nikbakht M, Khalili H. Delayed Hemolytic Anemia after Treatment with Artesunate: Case Report and Literature Review. Curr Drug Saf 2019; 14:60-66. [PMID: 30411691 DOI: 10.2174/1574886313666181109150157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/20/2018] [Accepted: 11/06/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent years, few cases of post-artemisinin delayed hemolysis have been reported. OBJECTIVE All cases of post-artemisinin delayed hemolysis were reported from non-middle east areas. No case of post-artemisinin delayed hemolysis has yet been reported from this region. In this paper, we describe a case of post-artemisinin delayed hemolysis in an Iranian female. Moreover, previous reports have been reviewed. METHODS Patient's data including demographic characteristics, past medical, drug and travelling history, present illness, vital signs, laboratory data, clinical course of current illness and follow-up findings were considered. RESULTS A 27-year-old female with a recent travel history to Ghana admitted with severe falciparum malaria. She was successfully treated with parenteral artesunate. However after 12 days of post artesunate treatment, she returned with dark urine, malaise and fatigue. CONCLUSION Considering the clinical course and base on a reliable causality assessment scale, post artesunate delay hemolytic anemia was possible.
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Affiliation(s)
- Mohammadreza Salehi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Masoumi-Asl
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehrdad Assarian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Khoshnam-Rad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Motevalli Haghi
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Nikbakht
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Camprubí D, Pereira A, Rodriguez-Valero N, Almuedo A, Varo R, Casals-Pascual C, Bassat Q, Malvy D, Muñoz J. Positive direct antiglobulin test in post-artesunate delayed haemolysis: more than a coincidence? Malar J 2019; 18:123. [PMID: 30961636 PMCID: PMC6454619 DOI: 10.1186/s12936-019-2762-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delayed haemolysis is a frequent adverse event after treatment with artesunate (AS). Removing once-infected "pitted" erythrocytes by the spleen is the most accepted mechanism of haemolysis in these cases. However, an increasing number of cases with positive direct antiglobulin test (DAT) haemolysis after AS have been reported. METHODS All malaria cases seen at Hospital Clinic of Barcelona between 2015 and 2017 were retrospectively reviewed. Clinical, parasitological and laboratory data from patients treated with intravenous artesunate-specifically looking for delayed haemolysis and DAT-was collected. RESULTS Among the 36 severe malaria patients treated with artesunate at the hospital, 10 (27.8%) developed post-artesunate delayed haemolysis. Out of these, DAT was performed in six, being positive in four of them (at least 40%). DAT was positive only for complement-without IgG-suggesting drug-dependent immune-haemolytic anaemia of the immune-complex type. Three of the four patients were treated with corticosteroids and two also received blood transfusion, with a complete recovery. CONCLUSIONS Drug-induced auto-immune phenomena in post-artesunate delayed haemolysis may be underreported and must be considered. The role of corticosteroids should be reassessed.
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Affiliation(s)
- Daniel Camprubí
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | - Arturo Pereira
- Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Alex Almuedo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Internal Medicine Department, Hospital General de Granollers, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Centro de Investigaçao em Saúde de Manhiça (CISM), Maputo, Mozambique
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Denis Malvy
- Travel Clinics and Tropical Diseases Unit, University Hospital Center of Bordeaux, Bordeaux, France
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Antinori S, Sollima S, Corbellino M, Ridolfo AL. Severe imported falciparum malaria. Dilemmas regarding treatment availability and tolerability. Travel Med Infect Dis 2018; 25:13-15. [PMID: 30171893 DOI: 10.1016/j.tmaid.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milano, Italy.
| | - Salvatore Sollima
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milano, Italy
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Safety Experience During Real-World Use of Injectable Artesunate in Public Health Facilities in Ghana and Uganda: Outcomes of a Modified Cohort Event Monitoring Study (CEMISA). Drug Saf 2018; 41:871-880. [PMID: 29696507 PMCID: PMC6061362 DOI: 10.1007/s40264-018-0667-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Injectable artesunate (Inj AS) is the World Health Organization (WHO)-recommended product for treating severe malaria. However, despite widespread usage, there are few published safety studies involving large populations in real-world settings. In this study, we sought to assess the incidence of common adverse events (AEs) following the intake of Inj AS in real-life settings. Methods This is a modified cohort event monitoring study involving patients who were administered with Inj AS at eight sites (four each in Ghana and Uganda) between May and December 2016. Patients were eligible for inclusion if they had severe/complicated malaria and were able and willing to participate in the study. Eligible patients were followed up by telephone or hospital or home visit on Days 7, 14, 21 and 28 after drug administration to document AEs and serious AEs (SAEs). Patients were also encouraged to report all AEs at any time during the study period. The Kaplan–Meier method was used to estimate the proportion of patients with any AEs by end of Day 28. Causality assessment was made on all AEs/SAEs using the WHO/UMC (Uppsala Monitoring Centre) causality method. Results A total of 1103 eligible patients were administered Inj AS, of which 360 patients were in Ghana and 743 in Uganda. The incidence of any AE by the end of follow-up among patients treated with AS was estimated to be 17.9% (197/1103) (95% confidence interval [CI] 15.8–20.3). The median time-to-onset of any AEs was 9 days (interquartile range (IQR) = 4, 14). The top five AEs recorded among patients treated with AS were pyrexia (3.5%), abdominal pain (2.5%), diarrhoea (1.7%), cough (1.5%) and asthenia (1.5%). Most of these top five AEs occurred in the first 14 days following treatment. Regarding the relatedness of these AEs to Inj AS, 78.9% of pyrexia (30/38), 63.0% of pain (17/27), 68.4% of diarrhoea (13/19), 85.5% of cough (14/16) and 75.0% of asthenia (12/16) were assessed as ‘possibly’ related. There were 17 SAEs including 13 deaths. Two of the deaths are ‘possibly’ related to Inj AS, as were three non-fatal SAEs: severe abdominal pain, failure of therapy and severe anaemia. Conclusion The incidence of common AEs among patients treated with Inj AS in real-world settings was found to be relatively low. Future studies should consider larger cohorts to document rare AEs as well. ClinicalTrials.gov Identifier NCT02817919.
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Nakamura-Uchiyama F, Katanami Y, Kikuchi T, Takaya S, Kutsuna S, Kobayashi T, Mizuno Y, Hasegawa T, Koga M, Yoshimura Y, Hasegawa C, Kato Y, Kimura M, Maruyama H. Retrospective observational study of the use of artemether-lumefantrine in the treatment of malaria in Japan. Travel Med Infect Dis 2018; 22:40-45. [PMID: 29454051 DOI: 10.1016/j.tmaid.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Research Group on Chemotherapy of Tropical Diseases, Japan, introduced artemether-lumefantrine (AL) in late 2002, mainly for treating uncomplicated Plasmodium falciparum malaria. Because AL was on the market in Japan in March 2017, the effectiveness and safety of AL were analyzed to help medical personnel use AL optimally. METHODS Case report forms submitted by the attending physicians were analyzed. When necessary, direct contact with the attending physicians was made to obtain detailed information. RESULTS Effectiveness analysis was performed for 62 cases and safety analysis was performed for 66 cases. In P. falciparum malaria, the overall cure rate was 91.1% (51/56), of which the cure rates for Japanese and non-Japanese patients were 82.1% (23/28) and 100% (28/28), respectively. The successfully treated cases included severe P. falciparum malaria, with parasite densities exceeding 500,000/μL. Adverse events were reported in 14 patients, including delayed hemolytic anemia which occurred in the top four highest parasitemic cases. CONCLUSIONS AL treatment failure in P. falciparum malaria may not be rare among non-immune individuals, including Japanese. The possibility of delayed hemolytic anemia, which occurs preferentially in high parasitemic cases, should be considered following AL treatment.
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Affiliation(s)
- Fukumi Nakamura-Uchiyama
- Department of Infectious Diseases, Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadashi Kikuchi
- Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Saho Takaya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Taiichiro Kobayashi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasutaka Mizuno
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuo Hasegawa
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Michiko Koga
- Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Yukihiro Yoshimura
- Department of Infectious Disease, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Chihiro Hasegawa
- Department of Infectious Diseases, Nagoya City East Medical Center, Nagoya, Japan
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mikio Kimura
- Department of Internal Medicine, Shin-Yamanote Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Haruhiko Maruyama
- Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
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Rodríguez-Morales AJ, Galindo-Marquez ML, Garcia-Robledo JE. Differences between observed and estimated by hematocrit hemoglobin and its implications in the diagnosis of anemia: Analysis of data derived from the PERU MIGRANT study (PEru's rural to urban MIGRANTs study). Travel Med Infect Dis 2017; 20:68-69. [PMID: 28993224 DOI: 10.1016/j.tmaid.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/25/2017] [Accepted: 10/05/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Alfonso J Rodríguez-Morales
- Public Health and Infection Research Incubator and Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia; Medical School, Faculty of Health Sciences, UniFranz, Cochabamba, Bolivia; Research Group Medical and Diagnostic Images (GRIMEID), IPS Imágenes Diagnósticas S.A., Pereira, Risaralda, Colombia.
| | - Maria Leonor Galindo-Marquez
- Public Health and Infection Research Incubator and Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia
| | - Juan Esteban Garcia-Robledo
- Public Health and Infection Research Incubator and Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, Colombia; School of Medicine, Faculty of Health Sciences, Universidad ICESI, Cl. 18 #122-135, Cali, Colombia
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