Vol.57 No.4 July 2009
A case of non-Japanese patient with severe co-infection with Plasmodium falciparum and Plasmodium malariae successfully treated with intravenous artesunate
1)Department of Infectious Diseases, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawa-dori, Kawasaki-ku, Kawasaki, Kanagawa, Japan
2)Department of Internal Medicine, Kawasaki Municipal Kawasaki Hospital
Abstract
A 37 year old Chinese male developed a continuous high-grade fever over 38°C on board a ship traveling from Papua New Guinea to China. The ship was diverted to Kawasaki port and he was brought to the emergency room of Kawasaki Municipal Kawasaki Hospital. The falciparum malaria was diagnosed morphologically by examination of blood films. According to the WHO criteria, the disease was considered to be severe because of high parasitemia at 15.2%. The initial treatment was with mefloquine (used first due to its good availability in Japan). However, the parasitemia did not improve and the morphological change of the parasites was not observed 12 hours after initiation of the treatment. Considering the time passed (4 days) since the onset of symptoms and the clinical condition, we consulted the Research Institute, International Medical Center of Japan who decided to donate us with a course of intravenous artesunate. Six hours after the first dose of artesunate, the infected RBC density decreased from 15% to 2% and the parasites observed were damaged morphologically. After 3 doses, no parasites were observed on blood film examination. In accordance with the disappearance of parasites, the clinical condition and laboratory data improved. The parasite clearance time and fever clearance time were 28 and 48 hours, respectively. The TaqMan real-time PCR system revealed that the patient was co-infected with Plasmodium falciparum and Plasmodium malariae.
Intravenous artesunate is reported to be highly safe and effective against severe falciparum malaria. We concluded that this treatment should become available in Japan for use against malaria in the near future.
Key word
artesunate, falciparum malaria
Received
January 29, 2009
Accepted
May 25, 2009
Jpn. J. Chemother. 57 (4): 311-315, 2009
