Post-Malaria Anemia Is Rare in Malawian Children with Cerebral Malaria

• Published in: The American journal of tropical medicine and hygiene 2021-06, Vol.104 (6), p.2146-2151
• Main Authors: Guenther, Geoffrey, Saidi, Alexuse M, Izem, Rima, Seydel, Karl, Postels, Douglas G
• Format: Article
• Language: English
• Subjects: Adolescent; Anemia; Anemia - epidemiology; Anemia - etiology; Anemia - parasitology; Antimalarials - therapeutic use; Child; Child, Preschool; Cohort Studies; Female; Hospitalization; Humans; Infant; Malaria; Malaria, Cerebral - complications; Malaria, Cerebral - drug therapy; Malaria, Cerebral - epidemiology; Malaria, Cerebral - mortality; Malaria, Falciparum - complications; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Malaria, Falciparum - mortality; Malawi - epidemiology; Male
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.20-1668

Artesunate therapy for severe malaria syndromes has been associated with post-treatment hemolysis and anemia. We defined post-malaria anemia as any decrease in hematocrit between the index hospitalization for severe malaria and 1 month after. We determined the incidence and severity of post-malaria anemia in Malawian children surviving cerebral malaria (CM) by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis. Children enrolled before 2014 and treated with quinine (N = 258) were compared with those admitted in 2014 and after, and treated with artesunate (N = 235). The last hematocrit value obtained during hospitalization was compared with the 1-month post-hospitalization hematocrit value. The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (11 of 235 or 4.7% for quinine, 15 of 258 or 5.8% for artesunate; odds ratio, 3.23 [0.88, 18.38]); no patients with a decrease in hematocrit were symptomatic, and none required transfusion after hospitalization. Of the 26 children who had a decrease in hematocrit 1 month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit level on admission, lower quantitative histidine-rich protein level, and splenomegaly were associated independently with post-malaria anemia. In African survivors of CM, post-malaria anemia is rare, mild, and unassociated with the anti-malarial treatment received.