Abstract
Abstract
Background
Standard treatment for both uncomplicated and severe malaria is artemisinin derivatives. Delayed parasite clearance times preceded the appearance of artemisinin treatment failures in Southeast Asia. Most worldwide malaria cases are in sub-Saharan Africa (SSA), where clinically significant artemisinin resistance or treatment failure has not yet been detected. The recent emergence of a resistance-conferring genetic mutation in the Plasmodium falciparum parasite in Africa warrants continued monitoring throughout the continent.
Methods
An analysis was performed on data from a retrospective cohort study of Malawian children with cerebral malaria admitted between 2010 and 2019 to a public referral hospital, ascertaining parasite clearance times across years. Data were collected from patients treated for severe malaria with quinine or artesunate, an artemisinin derivative. Parasite density was determined at admission and every subsequent 6 h until parasitaemia was below 1000 parasites/µl.The mean parasite clearance time in all children admitted in any one year was compared to the parasite clearance time in 2014, the first year of artesunate use in Malawi.
Results
The median population parasite clearance time was slower from 2010 to 2013 (quinine-treated patients) compared to 2014, the first year of artesunate use in Malawi (30 h (95% CI: 30–30) vs 18 h (95% CI: 18–24)). After adjustment for admission parasite count, there was no statistically significant difference in the median population parasite clearance time when comparing 2014 with any subsequent year.
Conclusion
Malaria parasite clearance times in Malawian children with cerebral malaria remained constant between 2014 and 2019, arguing against evolving artemisinin resistance in parasites in this region.
Funder
Robert H. Parrott Research, Education, Advocacy, and Child Health Care Program at Children’s National
Global Health Initiative at Children's National Medical Center
National Center for Advancing Translational Sciences
Division of Neurology, Children's National Medical Center
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Parasitology
Reference22 articles.
1. WHO. World Malaria Report. Geneva, World Health Organization, 2020.
2. WHO. Guidelines for the treatment of malaria. Geneva, World Health Organization, 2015.
3. Dondorp A, Nosten F, Stepniewska K, Day N, White N, group SEAQAMTS. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet. 2005;366:717–25.
4. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010;376:1647–57.
5. White NJ. Malaria parasite clearance. Malar J. 2017;16:88.