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Suspected Severe Malaria in a Sudanese Patient Affected by Sickle Cell Disease Who Was Treated with Hydroxyurea
Giulia Chiopris1,2, Stefano Maccario2, Tawaddud Hassan Eisa Artaiga2
1Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43126 Parma, Italy.
Insights
Sickle cell disease patients in malaria-endemic areas need routine malaria prophylaxis, even when on hydroxyurea (HU) treatment, especially post-splenectomy. This case highlights the risk of malaria recrudescence without prophylaxis.
Area of Science:
- Hematology
- Infectious Diseases
- Pediatrics
Background:
- Sickle cell disease (SCD) is a prevalent genetic disorder in sub-Saharan Africa, characterized by anemia, infections, and pain.
- Malaria is a significant infection risk for SCD patients in endemic regions, necessitating chemoprophylaxis.
- Hydroxyurea (HU) is a recognized treatment for SCD, with potential but unconfirmed impacts on malaria incidence and severity.
Purpose of the Study:
- To report a case of severe malaria with recrudescence in a child with SCD treated with HU.
- To emphasize the critical need for malaria prophylaxis in asplenic children with SCD, even with HU therapy.
Main Methods:
- Case report of an eight-and-a-half-year-old Sudanese boy with SCD.
- Patient was treated with hydroxyurea and admitted for suspected severe malaria.
- Documented malaria recrudescence after initial treatment in a patient who had undergone splenectomy and was not on chemoprophylaxis.
Main Results:
- The patient experienced malaria recrudescence despite first-line treatment.
- The case underscores the high risk of infectious complications in asplenic SCD patients.
- Lack of malaria chemoprophylaxis contributed to the adverse outcome.
Conclusions:
- Routine malaria prophylaxis is essential for children with SCD in endemic areas, irrespective of HU treatment.
- Asplenic status significantly increases infectious complication risk, mandating prophylaxis.
- Further research is needed to determine optimal malaria prophylaxis regimens and duration for SCD patients.
Abstract:
Sickle cell disease (SCD) is the most common genetic disease in sub-Saharan Africa. The signs and symptoms of SCD usually begin in early childhood. Characteristic features of this disorder include anaemia, repeated infections, and periodic episodes of pain. Malaria is one of the infections that can occur in patients with SCD in endemic countries. Many guidelines recommend antimalarial chemoprophylaxis in these patients, although the debate on which drug should be used is still ongoing. Hydroxyurea (HU), which is considered a safe and effective treatment for both children and adults with SCD, seems to affect the incidence and severity of malaria, although these impacts have yet to be fully demonstrated. We report a case of an eight-and-a-half-year-old Sudanese boy with SCD treated with HU admitted for suspected severe malaria who showed a recrudescence after first-line treatment. Although he had undergone splenectomy and thus belonged to a category of patients at high risk for infectious complications, he was not receiving any malaria chemoprophylaxis. This case emphasises the importance of the routine administration of malaria prophylaxis to children with SCD living in endemic areas, even when they are treated with HU, and especially if they are at high risk for infectious complications because they have undergone splenectomy. There is an urgent need for further research to evaluate the most appropriate regimen and its optimal duration.
