1
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Paccoud O, Chamillard X, Kendjo E, Vinatier I, Surgers L, Magne D, Wyplosz B, Angoulvant A, Bouchaud O, Izri A, Matheron S, Houzé S, Thellier M, Ndour AP, Buffet P, Caumes E, Jauréguiberry S. Favorable outcome without corticosteroids during post-artesunate delayed hemolysis with positive direct antiglobulin test in severe imported Plasmodium falciparum malaria, France. Int J Infect Dis 2023; 137:144-148. [PMID: 37926196 DOI: 10.1016/j.ijid.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/25/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Positive direct antiglobulin tests (DATs) have been reported in cases of post-artesunate delayed hemolysis (PADH), but the causal role of auto-immune hemolysis remains unclear. We aimed to analyze a cohort of patients with PADH and DAT during severe malaria. METHODS We describe PADH and DAT results in a 7-year multi-center retrospective cohort of patients receiving artesunate for severe imported malaria. RESULTS Of 337 patients treated with artesunate, 46 (13.6%) had at least one DAT result within 30 days of treatment initiation, and 25/46 (54.3%) had at least one positive DAT. Among 40 patients with available data, 17 (42.5%) experienced PADH. Patient characteristics were similar for patients with a positive or negative DAT, and DAT positivity was not associated with PADH occurrence (P = 0.36). Among patients, 5/13 (38.5%) with a positive DAT after day 7 experienced PADH, compared to 10/13 (76.9%) of those with a negative DAT after day 7 (P = 0.11). Overall, 41% of patients required blood transfusions, and outcome was favorable without corticosteroids, even in cases of PADH. CONCLUSIONS DAT does not appear to be a marker of PADH, but rather an indirect marker of an immune-mediated mechanism. DAT positivity should not lead to the administration of systemic corticosteroids during PADH.
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Affiliation(s)
- Olivier Paccoud
- Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Xavier Chamillard
- Etablissement Français du Sang (EFS) Ile-de-France, Laboratoire de Biologie Médicale de l'EFS Ile-de-France, Paris, France
| | - Eric Kendjo
- Centre National de Référence du Paludisme (NRC-M), Paris, France
| | - Isabelle Vinatier
- Etablissement Français du Sang (EFS) Ile-de-France, Laboratoire de Biologie Médicale de l'EFS Ile-de-France, Paris, France
| | - Laure Surgers
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France; Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Denis Magne
- Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Laboratoire de Mycologie et Parasitologie, Hôpital Saint-Antoine, Paris, France
| | - Benjamin Wyplosz
- Université de Paris Saclay, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Adéla Angoulvant
- Université de Paris Saclay, Assistance Publique des Hôpitaux de Paris (AP-HP), Laboratoire de Mycologie et Parasitologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Olivier Bouchaud
- Université Sorbonne Paris Nord, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne, Bobigny, France; Société Française de Médecine des Voyages
| | - Arezki Izri
- Université Sorbonne Paris Nord, Assistance Publique des Hôpitaux de Paris (AP-HP), Laboratoire de Mycologie et Parasitologie, Hôpital Avicenne, Bobigny, France
| | - Sophie Matheron
- Université de Paris, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France
| | - Sandrine Houzé
- Université de Paris, IRD, MERIT, Paris, France; Université de Paris, Assistance Publique des Hôpitaux de Paris (AP-HP), Laboratoire de Mycologie et Parasitologie, Hôpital Bichat Claude Bernard, Paris, France
| | - Marc Thellier
- Centre National de Référence du Paludisme (NRC-M), Paris, France; Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Laboratoire de Mycologie et Parasitologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Alioune P Ndour
- Université de Paris, INSERM, Biologie Intégrée du Globule Rouge, Laboratoire d'excellence GR-Ex, France
| | - Pierre Buffet
- Université de Paris, INSERM, Biologie Intégrée du Globule Rouge, Laboratoire d'excellence GR-Ex, France
| | - Eric Caumes
- Sorbonne Université, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital de la Pitié-Salpêtrière, Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France; Société Française de Médecine des Voyages
| | - Stéphane Jauréguiberry
- Centre National de Référence du Paludisme (NRC-M), Paris, France; Université de Paris Saclay, Assistance Publique des Hôpitaux de Paris (AP-HP), Service des Maladies Infectieuses et Tropicales, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Société Française de Médecine des Voyages; Université de Paris Saclay, INSERM, Centre de Recherche en Epidémiologie et Santé des Populations, Villejuif, France.
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2
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Durán Sánchez SJ, Amaya J, Medina L, Muñeton G, Vargas MJ, Faccini-Martínez ÁA. Malarial hepatopathy followed by delayed hemolysis after artemether-lumefantrine therapy for Plasmodium falciparum infection in a Colombian patient. Travel Med Infect Dis 2023; 55:102628. [PMID: 37567430 DOI: 10.1016/j.tmaid.2023.102628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Affiliation(s)
| | - Juliana Amaya
- Facultad de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Leidy Medina
- Servicio de Medicina Interna, Hospital Militar Central, Bogotá, D.C., Colombia
| | - Gerardo Muñeton
- Servicio de Infectología, Hospital Militar Central, Bogotá, D.C., Colombia
| | - María José Vargas
- Servicio de Medicina Interna, Hospital Militar Central, Bogotá, D.C., Colombia
| | - Álvaro A Faccini-Martínez
- Servicio de Infectología, Hospital Militar Central, Bogotá, D.C., Colombia; Servicios y Asesorías en Infectología - SAI, Bogotá, D.C., Colombia.
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3
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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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4
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Post-Artesunate Delayed Hemolysis: A Review of Current Evidence. Trop Med Infect Dis 2023; 8:tropicalmed8010049. [PMID: 36668956 PMCID: PMC9862382 DOI: 10.3390/tropicalmed8010049] [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] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Artesunate is the drug of choice for treating patients with severe malaria. Post-artesunate delayed hemolysis (PADH) is an uncommon adverse event from malaria treatment. Most patients with PADH are non-immune travelers. The pathophysiology of PADH is not fully understood, but the most likely mechanism is "pitting", in which red blood cells carrying dead parasites killed by artesunate's action are directed to the spleen for clearing the dead parasites. After the cleansing process, these red blood cells re-enter the circulation but with a smaller size and impaired integrity, resulting in a shortened lifespan of 7-21 days. Therefore, most patients with PADH usually present with clinical features of hemolytic anemia 7 days or later after the initiation of artesunate. To date, the benefits of artesunate treatment outweigh its adverse events, and no fatal cases have resulted from PADH. However, the hematological follow-up of patients with malaria treated with artesunate is recommended for clinicians to detect any delayed hemolytic event early and prevent potentially serious consequences.
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5
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Kurth F, Tober-Lau P, Lingscheid T, Bardtke L, Kim J, Angheben A, Gobbi FG, Mbavu L, Stegemann MS, Heim KM, Pfäfflin F, Menner N, Schürmann M, Mikolajewska A, Witzenrath M, Sander LE, Mayer B, Zoller T. Post-treatment haemolysis is common following oral artemisinin combination therapy of uncomplicated malaria in travellers. J Travel Med 2023; 30:6972275. [PMID: 36611010 DOI: 10.1093/jtm/taad001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 01/01/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND Artemisinin combination therapy (ACT) for the treatment of malaria is highly effective, well tolerated and safe. Episodes of delayed hemolysis occur in up to 57.9% of patients with severe malaria treated with intravenous artesunate, mainly caused by 'pitting' of infected red blood cells (RBCs) in the spleen and delayed loss of these once-infected RBCs (oiRBCs). Several reports indicate that post-treatment hemolysis (PTH) also occurs in uncomplicated malaria treated with oral ACT, calling for systematic investigation. METHODS Prospective observational study to identify the proportion of patients with PTH after oral ACT, defined as increased lactate dehydrogenase activity and low haptoglobin level on day 14 after treatment. Patients were enrolled at two study centres in Germany and Italy. Study visits took place on days 1, 3, 7, 14, 28. Laboratory investigations included extended clinical routine laboratory tests, quantitative P.f.-HRP2, anti-RBC antibodies, and oiRBCs. State of semi-immunity to malaria was assessed from childhood and ongoing exposure to Plasmodium spp. as per patient history. RESULTS A total of 134 patients with uncomplicated malaria and 3-day ACT treatment were recruited. Thirty-seven (37.4%) of 99 evaluable patients with P.f. and none of nine patients with non-P.f. malaria exhibited PTH on d14. Patients with PTH had higher initial parasitaemia, higher oiRBC counts on d3, and a 10-fold decrease in oiRBCs between d7 and d14 compared to patients without PTH. In patients with PTH, loss of haemoglobin (Hb) was 4-fold greater in non-Africans than in Africans (-1.3 vs -0.3 g/dl). Semi-immune African patients with PTH showed markedly increased erythropoiesis on d14 compared to not semi-immune African and non-African patients with PTH. CONCLUSIONS PTH is common in patients with uncomplicated malaria and oral ACT. While the observed loss of Hb will not be clinically relevant in most cases, it could aggravate pre-existing anaemia and warrants follow-up examinations in populations at risk.
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Affiliation(s)
- Florian Kurth
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pinkus Tober-Lau
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tilman Lingscheid
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lara Bardtke
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Kim
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Andrea Angheben
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico G Gobbi
- Department of Infectious/Tropical Diseases and Microbiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lena Mbavu
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Miriam S Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katrin M Heim
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frieder Pfäfflin
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nikolai Menner
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mariana Schürmann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Agata Mikolajewska
- Centre for Biological Threats and Special Pathogens, Robert Koch-Institut, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leif E Sander
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin
| | - Beate Mayer
- Institute for Transfusion Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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6
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Benjamin Y, Stead D. The sting in the tail of severe falciparum malaria: Post-artesunate delayed haemolysis. S Afr J Infect Dis 2022. [DOI: 10.4102/sajid.v37i1.392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Post-artesunate delayed haemolysis (PADH) is thought to occur because of delayed clearance of previously malarial infected erythrocytes spared by ‘pitting’ during treatment. We report a case of PADH following the treatment of Plasmodium (P.) falciparum malaria (32% parasitaemia), with a positive direct antiglobulin (DAT) test, suggesting an immune mechanism.
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7
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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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8
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O'Connor R, Conlan C, Grant C, Kinsella N, Moriarty M, Carr B, Melanophy G, Doyle C, Merry C, Bannan C, Bergin C. Delayed haemolysis after IV artesunate therapy for P. falciparum infection. Travel Med Infect Dis 2021; 45:102230. [PMID: 34915170 DOI: 10.1016/j.tmaid.2021.102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Colm Bergin
- St James Hospital, Dublin, Ireland; Trinity College, Dublin, Ireland
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9
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Gustafsson L, James S, Zhang Y, Thozhuthumparambil KP. Fatal case of delayed-onset haemolytic anaemia after oral artemether-lumefantrine. BMJ Case Rep 2021; 14:e245718. [PMID: 34799392 PMCID: PMC8606760 DOI: 10.1136/bcr-2021-245718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/03/2022] Open
Abstract
Artemisinin derivatives are used globally in the management of falciparum malaria. Postartemisinin delayed haemolysis (PADH) is a recognised adverse event contributing to severe anaemia. To the best of our knowledge, we report the first recorded fatal case of PADH. A 60-year-old woman presented with two episodes of collapse at home and feeling generally unwell. She had recently been treated for uncomplicated falciparum malaria 1 month prior with artemether 80 mg/lumefantrine 480 mg in Congo. Her results on admission revealed an anaemia (haemoglobin 43 g/L), raised lactate dehydrogenase and positive direct antiglobulin test that suggested an intravascular haemolytic process. She made a capacitous decision to refuse blood products in line with her personal beliefs. Despite best supportive treatment, she did not survive. This case highlights the importance of postartemisinin follow-up and should encourage discussion and careful consideration of its use in the context of lack of access to/patient refusal of blood products.
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Affiliation(s)
- Lotta Gustafsson
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sunil James
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Yimeng Zhang
- Department of Acute medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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10
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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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11
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Murai Y, Kawasuji H, Takegoshi Y, Kaneda M, Kimoto K, Ueno A, Miyajima Y, Kawago K, Fukui Y, Ogami C, Sakamaki I, Tsuji Y, Morinaga Y, Yamamoto Y. A case of COVID-19 diagnosed with favipiravir-induced drug fever based on a positive drug-induced lymphocyte stimulation test. Int J Infect Dis 2021; 106:33-35. [PMID: 33746092 PMCID: PMC7970795 DOI: 10.1016/j.ijid.2021.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
As of October 2020, there is still no specific drug to treat COVID-19 as it rages worldwide. Favipiravir, indicated for the treatment of new and re-emerging influenza infections, has been suggested to be effective against SARS-CoV-2, although this is not yet fully validated. We administered favipiravir to a 64-year-old female patient with COVID-19. Her symptoms resolved quickly after the start of treatment, with reduction of SARS-CoV-2 viral load, but she developed a fever again on day 12. Since the fever was relieved by discontinuation of favipiravir, and based on positive results with a drug-induced lymphocyte stimulation test, we diagnosed her with favipiravir-induced drug fever. A decrease in the serum concentration of favipiravir was observed along with resolution of the fever. The present case suggests that drug fever should be considered in the differential diagnosis of relapsing fever episodes in COVID-19 patients receiving favipiravir.
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Affiliation(s)
- Yushi Murai
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yusuke Takegoshi
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Makito Kaneda
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kou Kimoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Akitoshi Ueno
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yuki Miyajima
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Koyomi Kawago
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yasutaka Fukui
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Chika Ogami
- Department of Medical Pharmaceutics, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Ippei Sakamaki
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yasuhiro Tsuji
- Center for Pharmacist Education, School of Pharmacy, Nihon University, 3.7-7-1 Narashinodai, Funabashi, Chiba, 274-8555, Japan
| | - Yoshitomo Morinaga
- Department of Microbiology, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2.2630 Sugitani, Toyama, 930-0194, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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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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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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