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Kurth F, Develoux M, Mechain M, Malvy D, Clerinx J, Antinori S, Gjørup IE, Gascon J, Mørch K, Nicastri E, Ramharter M, Bartoloni A, Visser L, Rolling T, Zanger P, Calleri G, Salas-Coronas J, Nielsen H, Just-Nübling G, Neumayr A, Hachfeld A, Schmid ML, Antonini P, Lingscheid T, Kern P, Kapaun A, da Cunha JS, Pongratz P, Soriano-Arandes A, Schunk M, Suttorp N, Hatz C, Zoller T. Severe malaria in Europe: an 8-year multi-centre observational study. Malar J 2017; 16:57. [PMID: 28143519 PMCID: PMC5286792 DOI: 10.1186/s12936-016-1673-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/30/2016] [Indexed: 11/26/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Florian Kurth
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Matthieu Mechain
- Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France
| | - Denis Malvy
- Section Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, Department of Medicine, University Hospital Centre, Bordeaux, France
| | - Jan Clerinx
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences L.Sacco, University of Milano, Milan, Italy
| | - Ida E Gjørup
- Infectious Diseases Unit, Herlev University Hospital, Copenhagen, Denmark
| | - Joaquím Gascon
- ISGlobal, Barcelona Center for International Health Research. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Kristine Mørch
- Department of Medicine, National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Emanuele Nicastri
- National Institute of Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Michael Ramharter
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.,Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Alessandro Bartoloni
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leo Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thierry Rolling
- 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
| | - Philipp Zanger
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Guido Calleri
- Travel Medicine Unit, Department of Infectious Diseases, Amedeo di Savoia Hospital-ASLTO2, Turin, Italy
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Gudrun Just-Nübling
- Department of Internal Medicine II, Section Infectious Diseases and Tropical Medicine, University Hospital Frankfurt/Main, Frankfurt/Main, Germany
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Matthias L Schmid
- Department of Infection & Tropical Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Tilman Lingscheid
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Kern
- Comprehensive Infectious Diseases Center, Department of Internal Medicine III, Ulm University Hospital, Ulm, Germany
| | - Annette Kapaun
- Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Peter Pongratz
- Division of Tropical Medicine and Infectious Diseases, Center of Internal Medicine II, University of Rostock, Rostock, Germany
| | - Antoni Soriano-Arandes
- Hospital Universitari Joan XXIII, Tarragona, Spain.,Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Norbert Suttorp
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Thomas Zoller
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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