Analyse rétrospective de 107 cas de paludisme d’importation chez l’adulte

Vatan, R.; Pistone, Thierry; Millet, Pascal; Etienne, G; Mercié, P.; Longy‐Boursier, M.; Malvy, Denis

doi:10.1016/s0755-4982(06)74642-5

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…The rate of adverse events was 13%, better than that one of quinine but vomiting appeared to be specifically related to that regimen leading in a high proportion to a second-line treatment. Surprisingly, these digestive side-effects were not clearly reported in studies both performed in endemic areas or in non-endemic areas and were only suggested in one study on imported malaria [5,9,15,17,18,32,39,40]. …”

Section: Discussionmentioning

confidence: 99%

Therapy of uncomplicated falciparum malaria in Europe: MALTHER – a prospective observational multicentre study

Bouchaud

Mühlberger²,

Parola³

et al. 2012

Malar J

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BackgroundMalaria continues to be amongst the most frequent infectious diseases imported to Europe. Whilst European treatment guidelines are based on data from studies carried out in endemic areas, there is a paucity of original prospective treatment data. The objective was to summarize data on treatments to harmonize and optimize treatment for uncomplicated malaria in Europe.MethodsA prospective observational multicentre study was conducted, assessing tolerance and efficacy of treatment regimens for imported uncomplicated falciparum malaria in adults amongst European centres of tropical and travel medicine.ResultsBetween December 2003 and 2009, 504 patients were included in 16 centres from five European countries. Eighteen treatment regimens were reported, the top three being atovaquone-proguanil, mefloquine, and artemether-lumefantrine. Treatments significantly differed with respect to the occurrence of treatment changes (p = 0.005) and adverse events (p = 0.001), parasite and fever clearance times (p < 0.001), and hospitalization rates (p = 0.0066) and durations (p = 0.001). Four recrudescences and two progressions to severe disease were observed. Compared to other regimens, quinine alone was associated with more frequent switches to second line treatment, more adverse events and longer inpatient stays. Parasite and fever clearance times were shortest with artemether-mefloquine combination treatment. Vomiting was the most frequent cause of treatment change, occurring in 5.5% of all patients but 9% of the atovaquone-proguanil group.ConclusionsThis study highlights the heterogeneity of standards of care within Europe. A consensus discussion at European level is desirable to foster a standardized management of imported falciparum malaria.

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Section: Discussionmentioning

confidence: 99%

Therapy of uncomplicated falciparum malaria in Europe: MALTHER – a prospective observational multicentre study

Bouchaud

Mühlberger²,

Parola³

et al. 2012

Malar J

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“…With regard to efficacy, if a majority of patients (95%) were fever-free at day 3, nearly a third of them were still parasitaemic confirming that AP is slow-acting [ 15 , 16 , 19 , 20 , 30 , 31 ]. The analysis of efficacy in a per-protocol approach gives a cure rate of 99% (three relapses of 265 patients with a follow-up at one month) which is comparable to other treatments [ 15 , 16 , 22 , 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly, these digestive side effects are one of the most important from studies. A review of ten trials comparing Atovaquone-Proguanil (AP) with other anti-malarial drugs for uncomplicated malaria report a median rate of nausea and/or vomiting (inter quartile range) of 15.6% (5.2 – 25.0) for Atovaquone-Proguanil whereas other studies did not report this ADR [ 10 , 11 , 15 , 16 , 18 , 20 , 30 , 31 ],[ 39 ]. To discriminate digestive ADR from symptoms related to malaria is difficult in a cohort and only clinical trials would be able to make the distinction.…”

Section: Discussionmentioning

confidence: 99%

Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases

Cordel

Cailhol

Matheron

et al. 2013

Malar J

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BackgroundEach year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP’s efficacy and tolerance were evaluated in several trials, its use in “real life” conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas.MethodsBetween September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up.ResultsA total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8% were infected in West Africa, whereas 0.5% were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9% of the patients, the remainder (32.1%) were backpackers. Three-hundred and sixty-four patients (66%) fulfilled follow-up at day 7 and 265 (48%) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77%) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95% [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR.ConclusionThis study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.

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Le paludisme d’importation au CHU de Bordeaux de 2000 à 2007: épidémiologie, prise en charge et comparaison avec les données nationales

Pistone

Diallo

Receveur

et al. 2010

Bull. Soc. Pathol. Exot.

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In Western countries, France accounts for the most concerned by imported malaria. The objective of the present study was to describe the epidemiological and clinical features of imported malaria in adults attending the University Hospital Center (UHC) ofBordeaux and to compare these findings with the French national epidemiological data. A retrospective analysis of all patients aged over 15 years with parasitologically confirmed malaria in patients recruited between January 1, 2000 and December 31, 2007 has been performed. A total of 526 cases fitted the inclusion criteria with two-thirds of males and a mean age of 37 years. Patients were less frequently native from sub-Saharan Africa (SA), Madagascar, and Comoros than those from the French national data register (29 versus 72%). Hence, SA was the main destination (2/3 travelling to Western Africa and 1/3 to Central Africa). The recourse to an adequate chemoprophylaxis (CPL) for stays in areas of chemoresistance had been reported in about one-third of the patients. From these, two thirds were noncompliant. The recourse to chloroquine less frequent (6 versus 24%) among patients from Bordeaux compared to those from the national data register whereas the recourse to mosquito net use more frequent in patients from Bordeaux (36 versus 3%). Plasmodium falciparum was the main infective species.Malaria was more frequently associated with hospitalization (89 versus 71%) and with severe disease (9 versus 4%) in Bordeaux than in national data register. Two deaths were declared. Atovaquone-proguanil (AP) combination therapy wasmore frequently used in Bordeaux compared to the national data (64 versus 20%). This AP combination treatment was the most frequently prescribed for uncomplicated malaria, whereas intravenous quinine was mainly used for complicated malaria and for patients with vomiting. The lack of CPL, the diagnosis or therapeutic delay, and the lethality of malaria among travellers infected by malaria imported from SA argue for the implementation of continuing medical training and health education targeted at travellers from France to high malaria-endemic areas such as SA, Madagascar, and Comoros.

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Analyse rétrospective de 107 cas de paludisme d’importation chez l’adulte

Cited by 9 publications

References 12 publications

Therapy of uncomplicated falciparum malaria in Europe: MALTHER – a prospective observational multicentre study

Therapy of uncomplicated falciparum malaria in Europe: MALTHER – a prospective observational multicentre study

Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases

Le paludisme d’importation au CHU de Bordeaux de 2000 à 2007: épidémiologie, prise en charge et comparaison avec les données nationales

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