[Artesunate and Severe Malaria: The Importance of Proper Treatment Steps and Laboratory Monitoring].

Abstract

Malaria is a severe infectious disease caused by Plasmodium parasites transmitted by infected female Anopheles mosquitoes. Plasmodium falciparum is the leading cause of malaria-related deaths worldwide and can lead to severe complications such as coma, metabolic acidosis and renal failure. In this report a case of high-parasitemia P.falciparum infection diagnosed and treated with intravenous (IV) artesunate was presented. The patient was a 52-year-old male with a travel history to Liberia who was referred to a university hospital due to thrombocytopenia and hematochezia. Subsequently, the patient developed severe malaria symptoms, including metabolic acidosis and acute renal failure. Laboratory tests revealed a leukocyte count of 9370/mm³, hemoglobin level of 18.3 g/dL, platelet count of 11000/μL, aspartate aminotransferase of 57 U/L, alanine aminotransferase of 28 U/L, gama-glutamyl transferase of 160 U/L, lactate dehydrogenase of 629 U/L, total bilirubin of 8 mg/dL, direct bilirubin of 4.64 mg/ dL, creatinine of 1.69 mg/dL, prothrombin time of 14.9 seconds, international normalized ratio of 1.27, and C-reactive protein level of 247.7 mg/L. Giemsa-stained thin blood smear preparations, the Abbott Bioline™ Malaria Ag P.f/P.v rapid diagnostic test and real-time quantitative polymerase chain reaction confirmed P.falciparum infection. Intravenous artesunate and meropenem for secondary infections were administered, resulting in a rapid response to treatment. Parasite density was regularly monitored during treatment, and the patient was transitioned to oral therapy. According to the treatment algorithms of the World Health Organization and the Turkish Public Health Directorate, IV artesunate is the first-line treatment for severe malaria. In patients who have traveled to endemic regions and present with unexplained fever and flu-like symptoms, malaria should always be considered in the differential diagnosis and prompt diagnosis and treatment are crucial. Early diagnosis and the rapid action of artesunate significantly contribute to reducing morbidity and mortality rates. In this case, the rapid effect of artesunate and the significant decrease in parasitemia follow-up were clearly observed. In this case report, it was evaluated that parasitemia monitoring plays a critical role in directing patient treatment and is an important guide for clinicians and microbiologists.