Delayed-Onset Hemolytic Anemia in Patients with Travel-Associated Severe Malaria Treated with Artesunate, France, 2011–2013

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Jauréguiberry, Stéphane | Thellier, Marc | Ndour, Papa Alioune | Ader, Flavie | Roussel, Camille | Sonneville, Romain | Mayaux, Julien | Matheron, Sophie | Angoulvant, Adela | Wyplosz, Benjamin | Rapp, Christophe | Pistone, Thierry | Lebrun-Vignes, Bénédicte | Kendjo, Eric | Danis, Martin | Houzé, Sandrine | Bricaire, François | Mazier, Dominique | Buffet, Pierre | Caumes, Eric

Edité par CCSD ; Centers for Disease Control and Prevention -

French Artesunate Working Group. International audience. Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.

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