The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre

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 artesuna...

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Autores: Calvo-Cano, Antonia, Gómez Junyent, Joan, Lozano Molero, Miguel, Castro Rebollo, Pedro, Cid Vidal, Joan, Nicolás Arfelis, Josep Maria, Quintó, Llorenç, Martin, Maite, Muñoz, José, Gascón i Brustenga, Joaquim
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/98668
Acesso em linha:https://hdl.handle.net/2445/98668
Access Level:acceso abierto
Palavra-chave:Malària
Plasmodium falciparum
Malaria
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spelling The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centreCalvo-Cano, AntoniaGómez Junyent, JoanLozano Molero, MiguelCastro Rebollo, PedroCid Vidal, JoanNicolás Arfelis, Josep MariaQuintó, LlorençMartin, MaiteMuñoz, JoséGascón i Brustenga, JoaquimMalàriaPlasmodium falciparumMalariaPlasmodium falciparumBACKGROUND: 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.BioMed Central2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/98668Articles publicats en revistes (ISGlobal)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1264-zMalaria Journal, 2016, vol. 15, num. 216, p. 1-7http://dx.doi.org/10.1186/s12936-016-1264-zcc by (c) Calvo-Cano et al., 2016http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/986682026-05-27T06:46:51Z
dc.title.none.fl_str_mv The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
title The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
spellingShingle The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
Calvo-Cano, Antonia
Malària
Plasmodium falciparum
Malaria
Plasmodium falciparum
title_short The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
title_full The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
title_fullStr The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
title_full_unstemmed The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
title_sort The role of red blood cell exchange for severe imported malaria in the artesunate era: a retrospective cohort study in a referral centre
dc.creator.none.fl_str_mv Calvo-Cano, Antonia
Gómez Junyent, Joan
Lozano Molero, Miguel
Castro Rebollo, Pedro
Cid Vidal, Joan
Nicolás Arfelis, Josep Maria
Quintó, Llorenç
Martin, Maite
Muñoz, José
Gascón i Brustenga, Joaquim
author Calvo-Cano, Antonia
author_facet Calvo-Cano, Antonia
Gómez Junyent, Joan
Lozano Molero, Miguel
Castro Rebollo, Pedro
Cid Vidal, Joan
Nicolás Arfelis, Josep Maria
Quintó, Llorenç
Martin, Maite
Muñoz, José
Gascón i Brustenga, Joaquim
author_role author
author2 Gómez Junyent, Joan
Lozano Molero, Miguel
Castro Rebollo, Pedro
Cid Vidal, Joan
Nicolás Arfelis, Josep Maria
Quintó, Llorenç
Martin, Maite
Muñoz, José
Gascón i Brustenga, Joaquim
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malària
Plasmodium falciparum
Malaria
Plasmodium falciparum
topic Malària
Plasmodium falciparum
Malaria
Plasmodium falciparum
description 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.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/98668
url https://hdl.handle.net/2445/98668
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1264-z
Malaria Journal, 2016, vol. 15, num. 216, p. 1-7
http://dx.doi.org/10.1186/s12936-016-1264-z
dc.rights.none.fl_str_mv cc by (c) Calvo-Cano et al., 2016
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Calvo-Cano et al., 2016
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (ISGlobal)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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