Benjamin Mordmueller

Dorothee Spahlinger

Gerd D Burchard

Jakob P Cramer

Peter G Kremsner

Saadou Issifou

Thierry Rolling

Tsiri Agbeniyega

PubMed

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POSTER PRESENTATION Open Access
Extended haematological follow-up after
parenteral artesunate in African children with
severe malaria
Thierry Rolling1,2*, Dorothee Spahlinger1, Saadou Issifou3, Tsiri Agbeniyega4, Peter G Kremsner3,5,
Gerd D Burchard1,2, Benjamin Mordmueller3,5, Jakob P Cramer1,2
From Challenges in malaria research
Basel, Switzerland. 10-12 October 2012
Background
Mortality of severe malaria is significantly lower in
patients treated with parenteral artesunate when com-
pared to quinine. No significant side effects have been
described from previous studies but follow-up periods
have been limited.
First reports from Europe have shown cases of post-
treatment haemolysis occurring two weeks after the first
dose of parenteral artesunate. Furthermore, haemolysis
was accompanied by a delay in adequate reticulocytopoi-
esis for up to two weeks. All patients developing post-
treatment haemolysis had hyperparasitaemia. The aim of
this study was to gain information about the incidence,
clinical impact and pathophysiological background of this
effect in the hyperendemic setting of sub-Saharan Africa.
Materials and methods
This study was conducted as a substudy to the ongoing
Severe Malaria in African Children Follow-up study and
was implemented in Lambaréné, Gabon and Kumasi,
Ghana. 50 patients were recruited per study site.
Patients were randomized to different treatment regimes
of parenteral artesunate (3 doses of 4 mg/kg iv, im or 5
doses of 2.4 mg/kg im respectively). Haematological para-
meters and serum markers of haemolysis and erythropoi-
esis (lactate dehydrogenase, haptoglobin, bilirubine,
soluble transferrin receptor and erythropoietin) were
determined on days 0, 7, 14 and 28. The clinical impact of
changes in haemoglobin was assessed.
Results and conclusions
The preliminary results show a delay in the reticulopoietic
response after treatment of severe malaria, which is
accompanied by a slower recovery of haemoglobin levels
in hyperparasitaemic patients (>100,000 parasites/µl),
when compared to low parasitaemic patients. Hyperparasi-
taemic patients had a mean rise of 1.1 g/dL in Hb between
days 0 and 28, while patients with low parasitaemia had a
mean rise of 2.1 g/dL between days 0 and 28. First results
on the potential pathophysiologic background including
haemolysis and I or impaired erythropoiesis will be pre-
sented. In conclusion, there seems to an association
between parasite levels and recovery of haemoglobin
levels. Whether or not this effect is associated with malaria
disease, treatment with parenteral artesunate or both is
subject of further investigations.
Author details
1Department of Internal Medicine, Section of Tropical Medicine, University
Medical Centre Hamburg-Eppendorf, Hamburg, Germany. 2Department of
Clinical Research, Bernhard-Nocht-lnstitute for Tropical Medicine, Hamburg,
Germany. 3Medical Research Unit, Albert Schweitzer Hospital, Lambaréné,
Gabon. 4Kwame Nkrumah University of Science and Technology School of
Medicine, Kumasi, Ghana. 5Institute of Tropical Medicine, University of
Tübingen, Germany.
Published: 15 October 2012
doi:10.1186/1475-2875-11-S1-P83
Cite this article as: Rolling et al.: Extended haematological follow-up
after parenteral artesunate in African children with severe malaria.
Malaria Journal 2012 11(Suppl 1):P83.
1Department of Internal Medicine, Section of Tropical Medicine, University
Medical Centre Hamburg-Eppendorf, Hamburg, Germany
Full list of author information is available at the end of the article
Rolling et al. Malaria Journal 2012, 11(Suppl 1):P83
http://www.malariajournal.com/content/11/S1/P83
© 2012 Rolling et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Extended haematological follow-up after parenteral artesunate in African children with severe malaria

http://dx.doi.org/10.1186/1475-2875-11-S1-P83

Extended haematological follow-up after parenteral artesunate in African children with severe malaria

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