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Título:
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The role of red blood cell exchange for severe imported malaria
in the artesunate era: a retrospective cohort study in a
referral centre
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Autor/a:
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Calvo-Cano, Antonia; Gómez Junyent, Joan; Lozano Molero, Miguel; Castro, Pedro; Cid Vidal, Joan; Nicolás Arfelis, Josep Maria; Quintó, Llorenç; Martin, Maite; Muñoz, José; Gascón i Brustenga, Joaquim
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Notas:
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BACKGROUND: Intravenous artesunate has replaced quinine as the
first-line therapy for severe imported malaria, given its
anti-malarial superiority shown in clinical trials conducted in
endemic countries. Evidence for red blood cell (RBC) exchange in
patients with severe malaria treated with artesunate is lacking.
This retrospective cohort study describes the experience at
Hospital Clinic of Barcelona with the use of artesunate for
severe malaria and the joint use of RBC exchange in selected
cases. METHODS: Patients treated for severe malaria at Hospital
Clinic of Barcelona between August 2013 and January 2015 were
included in this retrospective study. Severe malaria was defined
according to WHO criteria. Data were extracted from electronic
hospital records. A log-linear mixed model approach was used to
estimate parasite clearance times. RESULTS: Within the study
period, 42 patients were diagnosed of malaria at this centre, of
which 38 had Plasmodium falciparum (90.5 %). Sixteen patients
(42 %) had severe malaria cases and were treated with
intravenous artesunate. Four patients underwent RBC exchange
within a period of 15 h after the first dose of artesunate
(range 9-21 h). The procedure lasted a median of 2 h (IQR 1.8-2
h), using a median of 12 (IQR 11-14) units of packed RBCs to
replace a median of 3794 ml (IQR 2977-4343). The technique was
well-tolerated without haemodynamic complications. There were no
deaths. The regression model showed an estimated time to 95 %
decay of 21.6 h (95 % CI 17.3-28.8). When assessing effect
modification by RBC exchange, there was no difference in the
parasite elimination rate (p = 0.286). DISCUSSION AND
CONCLUSION: In this study RBC exchange failed to show benefits
in terms of parasite clearance probably due to the small number
of patients analysed. The evidence for exchange transfusion
remains limited. |
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Materia(s):
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-Malària
-Plasmodium falciparum
-Malaria
-Plasmodium falciparum |
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Derechos:
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cc by (c) Calvo-Cano et al., 2016
http://creativecommons.org/licenses/by/3.0/es/
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Tipo de documento:
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Artículo
Artículo - Versión publicada |
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Editor:
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BioMed Central
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Compartir:
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