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CASE REPORT
A Case of Severe Falciparum Malaria Successfully Treated with Rectal Artesunate and Intravenous Quinine in Combination
1)Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, 2)Department of Rheumatology and Internal medicine, Yokohama Municipal Citizen's Hospital, 3)Deparment of Infectious Diseases, The University of Tokyo Hospital
Yuichiro AMANO1)2), Nobuyuki MIYATA1), Takumitsu SUZUKI3), Yukihiro YOSHIMURA1) & Natsuo TACHIKAWA1)
(Received October 23, 2017)
(Accepted May 15, 2018)
Key words: falciparum malaria, artesunate, quinine
Abstract

We report herein on a 61-year-old Japanese man with severe falciparum malaria after visiting African countries. He presented with shock, impaired consciousness, acidosis, renal impairment, jaundice, pulmonary edema and hyperparasitemia (42.7%). We admitted him to our intensive-care unit. He was initially treated with intravenous quinine (4,500 mg for 3 days), rectal artesunate (1,200 mg for 5days) and aggressive supportive therapy. The sequential treatment was mefloquine on day 7 (1,925 mg). The 99% parasite clearance time and ICU stay were 92 hours and 8days, respectively. He was discharged without complications on the 28th day. Severe malaria, especially cerebral malaria, is a highly mortal disease requiring urgent treatment. Intravenous artesunate is now recommended as the treatment of choice for severe malaria by the World Health Organization, but it is unavilable in Japan. We found that our combination treatment had excellent antimalarial activity with rapid efficacy, and was safe and well-tolerated.

[ Kansenshogaku Zasshi 92: 690-695, 2018 ]

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