lumefantrine and Acute-Kidney-Injury

Plasmodium knowlesi was known as a plasmodium of macaques until P. knowlesi transmission to humans was recognised in Borneo and later throughout South-East Asia. We describe here a case of a P. knowlesi infection imported to Germany from Thailand. The patient had not taken antimalarial chemoprophylaxis and suffered from daily fever attacks. Microscopy revealed trophozoites and gametocytes resembling P. malariae. P. knowlesi malaria was confirmed by PCR.

Topics: Acute Kidney Injury; Antimalarials; Artemether; Artemisinins; Ethanolamines; Female; Fluorenes; Germany; Humans; Lumefantrine; Malaria; Microscopy; Middle Aged; Plasmodium knowlesi; Polymerase Chain Reaction; Thailand; Travel; Treatment Outcome

The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.

Topics: Acute Kidney Injury; Adult; Antimalarials; Artemether; Artemisinins; Artesunate; Chloroquine; Ethanolamines; Female; Fluorenes; Hospitals, Urban; Humans; Lumefantrine; Malaria; Malaysia; Microscopy; Middle Aged; Parasitemia; Patient Selection; Plasmodium knowlesi; Polymerase Chain Reaction; Quinine; Respiratory Distress Syndrome; Severity of Illness Index; Shock; Survival Rate