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Severe Plasmodium knowlesi Malaria in a Tertiary Care Hospital, Sabah, Malaysia

2011; Centers for Disease Control and Prevention; Volume: 17; Issue: 07 Linguagem: Inglês

10.3201/eid1707.101017

1080-6059

Timothy William, Jayaram Menon, Giri Shan Rajahram, Leslie C. L. Chan, Melita A. Gordon, Samantha Donaldson, Serena Khoo, Charlie Fredrick, Jenarun Jelip, Nicholas M. Anstey, Tsin Wen Yeo,

Drug-Induced Hepatotoxicity and Protection

The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.