Division of Parasitic Diseases and Malaria, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Oberlin College, Department of Biology, Oberlin, Ohio, USA.
Clin Infect Dis. 2021 Dec 6;73(11):1965-1972. doi: 10.1093/cid/ciab570.
Severe malaria can be deadly and requires treatment with intravenous artesunate (IVAS). The Centers for Disease Control and Prevention provided IVAS starting 1 April 2019 for all patients with severe malaria in the United States. This study describes the safety and effectiveness of IVAS in these patients.
Patients meeting criteria for severe malaria April 2019-December 2020 who received IVAS were included. Demographic, clinical, laboratory, adverse event, and outcome information were collected. Clinical presentation, time to reach 1% and 0% parasitemia, adverse events, and death were described using proportions, medians, interquartile range (IQR), and tests of significance for differences in proportions.
Of 280 patients included, the majority were male (61.4%), Black (75.0%), with a median age of 35 years (IQR: 15.8-53.9). Most had Plasmodium falciparum (83.6%) with median parasitemia of 8.0% (IQR: 4.6-13.2). Of 170 patients with information, 159 (93.5%) reached ≤1% parasitemia by the third IVAS dose with a median time of 17.6 hours (IQR: 10.8-28.8), and 0% parasitemia in a median of 37.2 hours (IQR 27.2-55.2). Patients with parasite densities >10% and those requiring adjunct therapy had significantly higher parasite clearance times. Adverse events associated with IVAS were reported in 4.8% (n = 13 of 271). Eight patients had post-artesunate delayed hemolysis that resolved. There were 5 (1.8%) deaths, all attributable to severe malaria.
IVAS is a safe and effective drug for the treatment of severe malaria in the United States; timely administration can be lifesaving.
严重疟疾可能致命，需要静脉注射青蒿琥酯（IVAS）治疗。美国疾病控制与预防中心自 2019 年 4 月 1 日起为所有重症疟疾患者提供 IVAS。本研究描述了美国此类患者使用 IVAS 的安全性和有效性。
纳入符合标准的 2019 年 4 月至 2020 年 12 月期间接受 IVAS 治疗的重症疟疾患者。收集人口统计学、临床、实验室、不良事件和结局信息。采用比例、中位数、四分位距（IQR）和比例差异的显著性检验描述临床表现、达到 1%和 0%寄生虫血症的时间、不良事件和死亡。
共纳入 280 例患者，大多数为男性（61.4%）、黑人（75.0%），中位年龄为 35 岁（IQR：15.8-53.9）。大多数为恶性疟原虫感染（83.6%），中位寄生虫密度为 8.0%（IQR：4.6-13.2）。170 例有信息的患者中，159 例（93.5%）在接受第三剂 IVAS 后 17.6 小时内寄生虫密度降至≤1%（IQR：10.8-28.8），中位数 37.2 小时（IQR 27.2-55.2）降至 0%。寄生虫密度＞10%和需要辅助治疗的患者寄生虫清除时间显著延长。IVAS 相关不良事件报告发生率为 4.8%（271 例中的 13 例）。8 例患者出现青蒿琥酯后迟发性溶血，均已缓解。5 例（1.8%）死亡，均归因于严重疟疾。
IVAS 是美国治疗重症疟疾的一种安全有效的药物；及时给药可拯救生命。
