1Department of Pediatrics, Children's National Medical Center, Washington, District of Columbia.
2Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.
Am J Trop Med Hyg. 2021 Apr 26;104(6):2146-2151. doi: 10.4269/ajtmh.20-1668.
Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.
青蒿琥酯治疗严重疟疾综合征与治疗后溶血和贫血有关。我们将疟疾后贫血定义为严重疟疾住院期间和 1 个月后之间的血细胞比容下降。我们通过分析一项长期疟疾发病机制研究的住院和随访数据，确定了在马拉维幸存的脑疟疾（CM）儿童中疟疾后贫血的发生率和严重程度。与 2014 年之前入院并接受奎宁治疗的儿童（N = 258）相比，比较了在 2014 年及以后入院并接受青蒿琥酯治疗的儿童（N = 235）。将住院期间最后一次获得的血细胞比容值与住院后 1 个月的血细胞比容值进行比较。CM 幸存儿童中，住院后血细胞比容下降的总体发生率为 5.3%（235 例中的 11 例，奎宁为 4.7%，258 例中的 15 例，青蒿琥酯为 5.8%；比值比，3.23[0.88, 18.38]）；没有血细胞比容下降的患者有症状，且住院后无需输血。在 26 例住院后血细胞比容下降的儿童中，23.1%有新疟疾感染的证据。当将接受奎宁和青蒿琥酯治疗的儿童合并时，入院时较高的血细胞比容水平、较低的定量组氨酸丰富蛋白水平和脾肿大与疟疾后贫血独立相关。在非洲 CM 幸存者中，疟疾后贫血罕见、轻度且与接受的抗疟治疗无关。
