1- Unidade de Infeciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa.
- 39th Annual Meeting of European Society for Paediatric Infectious Diseases (ESPID) 2021; Reunião internacional. Publicação sobre a forma de resumo, poster e comunicação oral.
Resumo:
Introdução: Malaria should not be overlooked in a febrile child that has recently arrived from an endemic country. Artesunate,an IV artemisinine derivative, is now considered the first-line treatment for severe malaria albeit its limitedavailability in some European countries.
Relato de caso: A twelve-year-old previously healthy girl was admitted one day after arriving in Portugal from Guinea-Bissau with a two-day history of high-grade fever, headache, abdominal pain and generalized myalgia. She presented anemia (hemoglobin 10.0 g/dL, NR: 12.0-16.0), thrombocytopenia (78x109 /L, NR: 150-450) and significant elevation of inflammatory markers (PCR 301.0 mg/L, NR<5, and procalcitonin >100 ng/mL, NR<0.1). Severe Plasmodium falciparum malaria was diagnosed due to hyperparasitemia (28.5%/erythrocytes – 11.872.000 parasites/μL) and cerebral malaria with severe lethargy and persistent vomiting and cytotoxic lesions of the corpus callosum (CLOCCs) on brain MRI, although there was not any electroencephalographic evidence of epileptic activity. IV quinine and clindamycin were administered, with progressive clinical improvement and lowering parasitemia. IV artesunate was not administered because it was not immediately available. Oral therapy with artemeter/lumefantrine was started 5 days later, after oral intake was resumed, parasite clearance since day 3 and the patient was discharged without symptoms on day 8.
Conclusões: Although the use of IV artemisinine derivates has risen over the last years in several European countries, its availability remains scarce since it does not possess a manufacturing and marketing license in the European Union. The need for a nationally centralized authorization as well as European regulation should be reviewed, particularly in cases of severe malaria with high risk of multi-organ failure and death, where the bureaucratic hurdles may hinder its timely administration.
Palavras Chave: Malária cerebral; Artesunato; CLOCCs.