Severe malaria in Europe: an 8-year multi-centre observational study

Area of Science:

• Tropical Medicine
• Infectious Diseases
• Clinical Pharmacology

Background:

• Malaria remains a significant health threat for international travelers.
• Lack of standardized guidelines leads to varied treatment approaches for severe malaria in Europe.

Purpose of the Study:

• To analyze the epidemiology, treatment practices, and outcomes of severe malaria in European centers.
• To assess the safety and efficacy of current treatment regimens, including intravenous artesunate.

Main Methods:

• An 8-year, multicenter, observational study involving 185 patients with severe Plasmodium falciparum malaria across 12 European countries.
• Retrospective data collection on patient demographics, infection origin, treatment protocols, and clinical outcomes.
• Analysis of treatment variations and patient outcomes based on age and specific complications.

Main Results:

• A 28-day survival rate of 98.4% was observed, with most infections acquired in West Africa.
• Intravenous artesunate use increased significantly, with 56 different drug combinations employed across centers.
• Older patients (≥60 years) faced higher risks of acute renal failure and cerebral malaria; respiratory distress correlated with mortality.
• Post-artemisinin delayed hemolysis occurred in 27% of patients treated with intravenous artesunate.

Conclusions:

• Intravenous artesunate is increasingly utilized and appears safe for treating severe malaria in European patients.
• Close monitoring for delayed hemolytic events is crucial for patients receiving intravenous artesunate.
• Travelers and migrants returning from West Africa represent a significant proportion of severe malaria cases in Europe.