1 research outputs found
an 8-year multi-centre observational study
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