Severe malaria in Europe: an 8-year multi-centre observational study

Florian Kurth; Michel Develoux; Matthieu Mechain; Denis Malvy; Jan Clerinx; Spinello Antinori; Ida E. Gjorup; Joaquim Gascon; Kristine Morch; Emanuele Nicastri; Michael Ramharter; Alessandro Bartoloni; Leo Visser; Thierry Rolling; Philipp Zanger; Guido Calleri; Joaquin Salas-Coronas; Henrik Nielsen; Gudrun Just-Nuebling; Andreas Neumayr; Anna Hachfeld; Matthias L. Schmid; Pietro Antonini; Tilman Lingscheid; Peter Kern; Annette Kapaun; Jose Saraiva da Cunha; Peter Pongratz; Antoni Soriano-Arandes; Mirjam Schunk; Norbert Suttorp; Christoph Hatz; Thomas Zoller

doi:10.1186/s12936-016-1673-z

Severe malaria in Europe: an 8-year multi-centre observational study

Florian Kurth, Michel Develoux, Matthieu Mechain, Denis Malvy, Jan Clerinx, Spinello Antinori, Ida E. Gjorup, Joaquim Gascon, Kristine Morch, Emanuele Nicastri, Michael Ramharter, Alessandro Bartoloni, Leo Visser, Thierry Rolling, Philipp Zanger, Guido Calleri, Joaquin Salas-Coronas, Henrik Nielsen, Gudrun Just-Nuebling, Andreas NeumayrAnna Hachfeld, Matthias L. Schmid, Pietro Antonini, Tilman Lingscheid, Peter Kern, Annette Kapaun, Jose Saraiva da Cunha, Peter Pongratz, Antoni Soriano-Arandes, Mirjam Schunk, Norbert Suttorp, Christoph Hatz, Thomas Zoller

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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, multi-centre, 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.

Original language	English
Article number	57
Journal	Malaria Journal
Volume	16
Number of pages	11
ISSN	1475-2875
DOIs	https://doi.org/10.1186/s12936-016-1673-z
Publication status	Published - 2017

Keywords

Malaria
Falciparum
Severe malaria
Artesunate
Quinine
Plasmodium
Europe
Clinical study
IMPORTED FALCIPARUM-MALARIA
BLOOD-CELL EXCHANGE
INTENSIVE-CARE-UNIT
INTRAVENOUS ARTESUNATE
DELAYED HEMOLYSIS
RETROSPECTIVE COHORT
PARASITE CLEARANCE
AFRICAN CHILDREN
RISK-FACTORS
QUININE

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Kurth, F., Develoux, M., Mechain, M., Malvy, D., Clerinx, J., Antinori, S., Gjorup, I. E., Gascon, J., Morch, K., Nicastri, E., Ramharter, M., Bartoloni, A., Visser, L., Rolling, T., Zanger, P., Calleri, G., Salas-Coronas, J., Nielsen, H., Just-Nuebling, G., ... Zoller, T. (2017). Severe malaria in Europe: an 8-year multi-centre observational study. Malaria Journal, 16, Article 57. https://doi.org/10.1186/s12936-016-1673-z

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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, multi-centre, 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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Kurth, F, Develoux, M, Mechain, M, Malvy, D, Clerinx, J, Antinori, S, Gjorup, IE, Gascon, J, Morch, K, Nicastri, E, Ramharter, M, Bartoloni, A, Visser, L, Rolling, T, Zanger, P, Calleri, G, Salas-Coronas, J, Nielsen, H, Just-Nuebling, 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 2017, 'Severe malaria in Europe: an 8-year multi-centre observational study', Malaria Journal, vol. 16, 57. https://doi.org/10.1186/s12936-016-1673-z

TY - JOUR

T1 - Severe malaria in Europe: an 8-year multi-centre observational study

AU - Kurth, Florian

AU - Develoux, Michel

AU - Mechain, Matthieu

AU - Malvy, Denis

AU - Clerinx, Jan

AU - Antinori, Spinello

AU - Gjorup, Ida E.

AU - Gascon, Joaquim

AU - Morch, Kristine

AU - Nicastri, Emanuele

AU - Ramharter, Michael

AU - Bartoloni, Alessandro

AU - Visser, Leo

AU - Rolling, Thierry

AU - Zanger, Philipp

AU - Calleri, Guido

AU - Salas-Coronas, Joaquin

AU - Nielsen, Henrik

AU - Just-Nuebling, Gudrun

AU - Neumayr, Andreas

AU - Hachfeld, Anna

AU - Schmid, Matthias L.

AU - Antonini, Pietro

AU - Lingscheid, Tilman

AU - Kern, Peter

AU - Kapaun, Annette

AU - da Cunha, Jose Saraiva

AU - Pongratz, Peter

AU - Soriano-Arandes, Antoni

AU - Schunk, Mirjam

AU - Suttorp, Norbert

AU - Hatz, Christoph

AU - Zoller, Thomas

N1 - FTX

PY - 2017

Y1 - 2017

N2 - 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, multi-centre, 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.

AB - 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, multi-centre, 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.

KW - Malaria

KW - Falciparum

KW - Severe malaria

KW - Artesunate

KW - Quinine

KW - Plasmodium

KW - Europe

KW - Clinical study

KW - IMPORTED FALCIPARUM-MALARIA

KW - BLOOD-CELL EXCHANGE

KW - INTENSIVE-CARE-UNIT

KW - INTRAVENOUS ARTESUNATE

KW - DELAYED HEMOLYSIS

KW - RETROSPECTIVE COHORT

KW - PARASITE CLEARANCE

KW - AFRICAN CHILDREN

KW - RISK-FACTORS

KW - QUININE

U2 - 10.1186/s12936-016-1673-z

DO - 10.1186/s12936-016-1673-z

M3 - A1: Web of Science-article

SN - 1475-2875

VL - 16

JO - Malaria Journal

JF - Malaria Journal

M1 - 57

ER -

Severe malaria in Europe: an 8-year multi-centre observational study

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Keywords

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