@article{fdi:010092945,
  title = {{P}ost-artesunate delayed hemolysis in {A}frican children with severe malaria : incidence, medical impact and prevention},
  author = {{C}arret, {V}. and {S}ossou, {D}. and {Y}akoubou, {A}. and {F}ievet, {N}adine and {G}ay, {F}. and {T}ielli, {A}. and {C}hambrion, {C}. and {F}ernando, {A}. and {H}oungbegnon, {P}. and {A}llaf, {B}. and {N}ouatin, {O}. and {A}dimi, {E}. and {A}koho, {R}. and {D}iallo, {A}. and {C}hadli, {N}. and {O}uorou, {R}. and {B}ello, {E}. and {L}inard, {C}. and {K}oehl, {B}. and {M}assougbodji, {A}. and {T}audon, {N}. and {S}iriez, {J}. {Y}. and {B}uffet, {P}. and {A}lao, {J}. and {N}dour, {P}. {A}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {P}ost-artesunate delayed hemolysis ({PADH}) occurs in 7%-25% of adults with severe imported malaria. {W}hether it exists in {A}frican children is controversial. {M}ethods {I}n total, 351 children treated with artesunate were enrolled in a prospective severe malaria study in {B}enin. {C}linical, epidemiological and biological data, plasma concentrations of antimalarials were captured or determined on admission then at 3, 5, 14, 21, and 28 days after starting treatment. {PADH} was defined by a >10% drop in hemoglobin level and/or a >10% rise in {LDH} concentrations beyond {D}ay 5. {R}esults {F}ourteen children (4%) died before {D}14. {A}lthough 10% of guardians declared administration of anti-malarial drugs before admission, 316/350 (90%) of children had measurable plasma levels of lumefantrine (n = 279), quinine (n = 104), sulfadoxine (n = 67), artemisinin (n = 28), chloroquine (n = 16), or other antimalarials (n = 9). {PADH} occurred in 76/332 children (22.9%). {L}evels of pitted red blood cells ({RBC}) were higher and recovery from anemia was slower in these children. {S}evere anemia and transfusion were more frequent between {D}14 and {D}28 in children with {PADH} compared to children without {PADH} (10.6% vs 0.4%, 9.8% vs 0%). {D}uring follow-up, children with {PADH} were more frequently hospitalized (11.1% vs 1.6%) and had more frequent infectious events (6.9% vs 0.4%) than children without {PADH}. {C}hildren who received 2 transfusions within 3 days post-admission had a lower incidence of {PADH} than untransfused children (12.5% vs 26.8%, {P} = .015). {C}onclusions {D}espite widespread self-medication with antimalarials, {PADH} affects 23% of {A}frican children treated with artesunate for severe malaria, of whom more than 15% suffer from severe anemia and/or infectious events. {L}iberal early transfusion may be protective against {PADH}.},
  keywords = {severe malaria anemia ; post-artesunate-delayed hemolysis ; pitting ; self-medication in {A}frican {C}hildren ; {PADH} and transfusion ; {BENIN}},
  booktitle = {},
  journal = {{C}linical {I}nfectious {D}iseases},
  volume = {[{E}arly access]},
  numero = {},
  pages = {[8 p.]},
  ISSN = {1058-4838},
  year = {2025},
  DOI = {10.1093/cid/ciaf067},
  URL = {https://www.documentation.ird.fr/hor/fdi:010092945},
}