[Parenteral combined quinine-artesunate therapy in life-threatening malaria]

A 31-year old French woman of congolese origin was referred to the intensive care unit of our University Hospital after a visit to the Democratic Republic of Congo in a highly febrile and semi-conscious status.

Microscopy of stained thin and thick blood films revealed Plasmodium falciparum trophzoites with a high parasitaemia of 50 % and confirmed the clinical suspicion of a life-threatening malaria.

Immediate intravenous quinine with a loading dose of 20 mg/kg body weight was initiated followed by 10 mg/kg every 8 hrs. Since the patient lost consciousness, artesunate was added six hours later in the recommended dose of 2.4 mg/kg immediately, repeated after 12 and 24 hrs, followed by a daily dose of 2.4 mg/kg. Furthermore, clindamycin at a dose of 20 mg/kg body weight / d i. v. was given. Anaemia was corrected by 4 erythrocyte concentrates until a haemoglobina concentration of 9.6 g/dl was reached. Now the patient rapidly recovered, and parasitaemia dropped to 0.1 % within 24 hrs. Already the following day blood films cleared completely from malaria parasites.

The case illustrates the rapid efficacy of a combined parenteral quinine-artesunate therapy in life-threatening falciparum malaria with an unusually high parasitaemia.