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Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury

Plewes, Katherine, Haider, Md Shafiul, Kingston, Hugh W. F., Yeo, Tsin W., Ghose, Aniruddha, Hossain, Md Amir, Dondorp, Arjen M., Turner, Gareth D.H. and Anstey, Nicholas M. (2015). Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury. Malaria Journal,14(Article No. 246).

Document type: Journal Article
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IRMA ID 75039815xPUB979
NHMRC Grant No. 605807
Title Severe falciparum malaria treated with artesunate complicated by delayed onset haemolysis and acute kidney injury
Author Plewes, Katherine
Haider, Md Shafiul
Kingston, Hugh W. F.
Yeo, Tsin W.
Ghose, Aniruddha
Hossain, Md Amir
Dondorp, Arjen M.
Turner, Gareth D.H.
Anstey, Nicholas M.
Journal Name Malaria Journal
Publication Date 2015
Volume Number 14
Issue Number Article No. 246
ISSN 1475-2875   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84934949362
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
Severe falciparum malaria may be complicated by haemolysis after parasite clearance, however the mechanisms remain unclear. Recent reports describe a pattern of delayed onset haemolysis among non-immune travellers with hyperparasitaemia treated with intravenous artesunate, termed post-artesunate delayed haemolysis (PADH). The occurrence and clinical impact of PADH following severe malaria infections in areas of unstable transmission are unknown.

Case

A 45-year-old Bangladeshi male was initially admitted to a local hospital with severe falciparum malaria complicated by hyperparasitaemia and treated with intravenous artesunate. Twenty days from his first presentation he was readmitted with delayed onset haemolytic anaemia and acute kidney injury. Multiple blood transfusions and haemodialysis were required. Renal biopsy revealed acute tubular injury and haem pigment nephropathy. His haemoglobin and renal function recovered to baseline after 62 days from his second admission.

Discussion

This case highlights the differential diagnosis of post-malaria delayed onset haemolysis, including the recently described syndrome of post-artemisinin delayed haemolysis. The pathophysiology contributing to acute kidney injury in this patient and the limited treatment options are discussed.

Conclusions
This report describes PADH complicated by acute kidney injury in an adult patient living in a malaria hypoendemic region who subsequently required blood transfusions and haemodialysis. This case emphasizes the importance of routine follow up of haemoglobin and renal function in artesunate-treated patients who have recovered from severe malaria.
Keywords Falciparum malaria
Delayed haemolysis
Acute kidney injury
DOI http://dx.doi.org/10.1186/s12936-015-0760-x   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
Additional Notes This is an Open Access article distributed under the terms of the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Description for Link Link to CC Attribution 4.0 License
URL https://creativecommons.org/licenses/by/4.0/au


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