Tsuchido Yasuhiro, Nakamura-Uchiyama Fukumi, Toyoda Kasumi, Iwagami Moritoshi, Tochitani Kentaro, Shinohara Koh, Hishiya Naokuni, Ogawa Taku, Uno Kenji, Kasahara Kei, Ouji Yukiteru, Kano Shigeyuki, Mikasa Keiichi, Shimizu Tsunehiro, Yoshikawa Masahide, Maruyama Haruhiko
Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan.
Center for Infectious Diseases, Nara Medical University, Nara, Japan.
Am J Trop Med Hyg. 2017 May;96(5):1185-1189. doi: 10.4269/ajtmh.16-0460. Epub 2017 Feb 13.
AbstractRecently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged. Here we report two cases of delayed hemolytic anemia in a patient with severe falciparum malaria after treatment with oral artemether-lumefantrine (AL). The first patient, a 20-year-old Japanese male student, was diagnosed with falciparum malaria and was administered AL. As having a high parasitemia rate (20.6%) was the only severe malaria criterion met in this case and his general condition was stable, we continued with AL treatment. Despite disappearance of malarial parasites after 4 days of AL administration, a persistent fever remained. On days 13 and 16, a diagnosis of hemolytic anemia was made (lactate dehydrogenase [LDH]: 1,466 U/L, hemoglobin [Hb]: 7.2 g/dL). A blood smear at that time revealed no parasites. He recovered naturally from delayed hemolysis. The second patient, a 27-year-old Japanese female student, was diagnosed with falciparum malaria (parasitemia: 4.5%) and treated initially with oral quinine hydrochloride and doxycycline. The following day, parasitemia increased to 7.9% and oral AL was initiated. She was discharged on day 4 after achieving parasite clearance and afebrility. However, on day 5, fever (body temperature > 38°C) recurred, and on day 11, a diagnosis of hemolytic anemia was made (LDH: 712 U/L, Hb: 8.8 g/dL). A follow-up confirmed that her condition improved gradually. AL treatment of severe malaria can cause delayed hemolytic anemia. Patients should be followed up for up to 4 weeks to detect signs of hemolysis and provide appropriate symptomatic treatment.
最近，出现了青蒿素及其衍生物治疗后发生迟发性溶血性贫血的报告。在此，我们报告2例严重恶性疟患者口服蒿甲醚-本芴醇（AL）治疗后发生迟发性溶血性贫血的病例。首例患者为一名20岁日本男学生，被诊断为恶性疟并接受AL治疗。由于该病例仅满足高疟原虫血症率（20.6%）这一严重疟疾标准且其一般状况稳定，我们继续进行AL治疗。尽管AL给药4天后疟原虫消失，但仍持续发热。在第13天和第16天，诊断为溶血性贫血（乳酸脱氢酶[LDH]：1466 U/L，血红蛋白[Hb]：7.2 g/dL）。当时的血涂片未发现疟原虫。他从迟发性溶血中自然康复。第二例患者为一名27岁日本女学生，被诊断为恶性疟（疟原虫血症：4.5%），最初接受口服盐酸奎宁和多西环素治疗。次日，疟原虫血症升至7.9%，开始口服AL治疗。在实现疟原虫清除和退热后，她于第4天出院。然而，在第5天，发热（体温>38°C）复发，在第11天，诊断为溶血性贫血（LDH：712 U/L，Hb：8.8 g/dL）。随访证实其病情逐渐改善。严重疟疾的AL治疗可导致迟发性溶血性贫血。应对患者进行长达4周的随访，以检测溶血迹象并提供适当的对症治疗。
