Manual blood exchange transfusion does not significantly contribute to parasite clearance in artesunate-treated individuals with imported severe Plasmodium falciparum malaria

Malaria Journal

Research

Annemarie R Kreeftmeijer-Vegter¹  Peter J de Vries²  Mariana de Mendonça Melo³  Perry JJ van Genderen³  Rob Koelewijn⁴  Jaap J van Hellemond⁵ 

[1] Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;ACE Pharmaceuticals BV, Schepenveld 41, 3891 ZK, Zeewolde, the Netherlands;Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands;Department of Internal Medicine, Tergooi Hospitals, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands;Department of Internal Medicine, Harbour Hospital, Haringvliet 72, 3011 TG, Rotterdam, The Netherlands;Institute for Tropical Diseases, Harbour Hospital, Haringvliet 72, 3011 TG, Rotterdam, The Netherlands;Laboratory of Parasitology, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands;Laboratory of Parasitology, Harbour Hospital, Haringvliet 2, 3011 TD, Rotterdam, The Netherlands;Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands;

关键词: Malaria;    Quinine;    Falciparum Malaria;    Severe Malaria;    Artesunate;   

DOI  :  10.1186/1475-2875-12-115

 received in 2012-10-07, accepted in 2013-03-12,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundExchange transfusion (ET) has remained a controversial adjunct therapy for the treatment of severe malaria. In order to assess the relative contribution of ET to parasite clearance in severe malaria, all patients receiving ET as an adjunct treatment to parenteral quinine or to artesunate were compared with patients treated with parenteral treatment with quinine or artesunate but who did not receive ET. ET was executed using a standardized manual isovolumetric exchange protocol.MethodsAll patients in the Rotterdam Malaria Cohort treated for severe P. falciparum malaria at the Institute for Tropical Diseases of the Harbour Hospital between 1999 and 2011 were included in this retrospective follow-up study. Both a two-stage approach and a log-linear mixed model approach were used to estimate parasite clearance times (PCTs) in patients with imported malaria. Severe malaria was defined according to WHO criteria.ResultsA total of 87 patients with severe malaria was included; 61 received intravenous quinine, whereas 26 patients received intravenous artesunate. Thirty-nine patients received ET as an adjunct treatment to either quinine (n = 23) or artesunate (n = 16). Data from 84 of 87 patients were suitable for estimation of parasite clearance rates. PCTs were significantly shorter after administration of artesunate as compared with quinine. In both models, ET did not contribute significantly to overall parasite clearance.ConclusionManual exchange transfusion does not significantly contribute to parasite clearance in artesunate-treated individuals. There may be a small effect of ET on parasite clearance under quinine treatment. Institution of ET to promote parasite clearance in settings where artesunate is available is not recommended, at least not with manually executed exchange procedures.

【 授权许可】

Unknown   
© Kreeftmeijer-Vegter et al.; licensee BioMed Central Ltd. 2013. This article is published under license to 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.