Enfermedades infecciosas y microbiologia clinica (English ed.) · 2026
Appropriateness of malaria treatment according to World Health Organization criteria for severe malaria in a non-endemic country.
СтатьяНазвание и аннотация: Перевод в очереди
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Pérez-Jacoiste Asín María Asunción, Navarro Flores Andrea, Alonso Crespo Anatolio, Pérez-Ayala Ana, Losada Galván Irene, de Dios Begoña, Hernández-Jiménez Pilar, Gil-Mosquera Manuel, Jiménez-Morillas Francisco, Lumbreras Carlos, Lizasoain Manuel, Herrero-Martínez Juan María
Аннотация
INTRODUCTION: The number of cases of malaria is increasing in Spain due to tourism and migration. Unfamiliarity with this disease may lead doctors to misrecognize its severity and over-/under-treat it. We aimed to analyse the adequacy of treatment according to malaria severity.
METHODS: Single-centre retrospective study at "Hospital 12 de Octubre" (Madrid). We identified all patients over 16-years-old with symptomatic malaria from January 2015 to December 2023. The severity of malaria was defined according to WHO criteria. Parenteral artesunate was the treatment of choice for severe malaria. Oral artemisinin combination or atovaquone/proguanil were used for non-severe malaria.
RESULTS: We identified 64 patients (median age 39.5 years (IQR 32,25-47), 75% Visiting Friends and Relatives. Malaria was severe in 15 patients (23.4%). Antimalarial treatment was adequate to severity in 46 patients (71.8%). Three cases classified as severe malaria received oral treatment while 15 cases apparently non-severe received parenteral artesunate. Those who received oral treatment for severe malaria had been misclassified (mild epistaxis, chronic renal insufficiency, and 3.5% parasitaemia in an immigrant). Among those treated parenterally for non-severe malaria, four had oral intolerance and in the remaining eleven, there was an overuse of artesunate. The main reason for artesunate overuse was the presence of thrombocytopenia (median platelet-count: 33,000/mm3, IQR: 28,000-51,000/mm3).
CONCLUSIONS: Antimalarial treatments were mostly adequate, especially in severe cases. The most common reason for artesunate overuse was the presence of thrombocytopenia, which is not included in the WHO criteria for severe malaria.
METHODS: Single-centre retrospective study at "Hospital 12 de Octubre" (Madrid). We identified all patients over 16-years-old with symptomatic malaria from January 2015 to December 2023. The severity of malaria was defined according to WHO criteria. Parenteral artesunate was the treatment of choice for severe malaria. Oral artemisinin combination or atovaquone/proguanil were used for non-severe malaria.
RESULTS: We identified 64 patients (median age 39.5 years (IQR 32,25-47), 75% Visiting Friends and Relatives. Malaria was severe in 15 patients (23.4%). Antimalarial treatment was adequate to severity in 46 patients (71.8%). Three cases classified as severe malaria received oral treatment while 15 cases apparently non-severe received parenteral artesunate. Those who received oral treatment for severe malaria had been misclassified (mild epistaxis, chronic renal insufficiency, and 3.5% parasitaemia in an immigrant). Among those treated parenterally for non-severe malaria, four had oral intolerance and in the remaining eleven, there was an overuse of artesunate. The main reason for artesunate overuse was the presence of thrombocytopenia (median platelet-count: 33,000/mm3, IQR: 28,000-51,000/mm3).
CONCLUSIONS: Antimalarial treatments were mostly adequate, especially in severe cases. The most common reason for artesunate overuse was the presence of thrombocytopenia, which is not included in the WHO criteria for severe malaria.