6%) with splenomegaly observed in 96 patients (33%) and jaundice in 17 (5.8%). The most common laboratory abnormalities observed in our case series were thrombocytopenia (239, 82%), elevated serum lactate dehydrogenase levels (276, 95%), elevations of liver transaminases (96, 33%), and anemia (89, 30%); only five patients (1.7%) had a hemoglobin level below 80 g/L. Plasmodium vivax-infected patients had lower mean platelet counts than P falciparum-infected subjects (86 × 109/L vs 97.9 × 109/L; p = 0.02). Quantification of parasites by direct microscopy was available on admission for 145 patients (49.8%) of whom 117 with P falciparum malaria (50%) and 28 (49.1%) with
P vivax/P ovale; in more detail, for the former, parasite counts ranged Navitoclax from 68/µL to 1,652,000/µL (median value 60,600/µL) with 26 patients showing a parasite count of more than 5% (median 338,000/µL, range 253,460–1,652,000/µL). For the latter, parasitemia ranged from 210/µL to 57,600/µL (median 1,340/µL). Of the 233 patients with P falciparum malaria, 35 (15%) fulfilled the WHO criteria for severe malaria; 19 patients (54.3%) had more than one WHO criteria; 6 patients (2.6%) were initially admitted to the intensive care unit (ICU) and 5 more patients were subsequently referred selleck inhibitor to the ICU (11 total patients requiring intensive care).
Four patients received exchange transfusion as adjunctive therapy; all patients recovered uneventfully, but those treated in ICU had longer hospital stay (median 16 d vs 4 d; p < 0.001). All patients, irrespective of the
infecting Plasmodium species were admitted to the hospital; drug regimens employed are reported in Table 1. In our case file, mefloquine, either alone (173, 59.4%) or in combination with other drugs (27, 9.3%), was the most frequently used drug. It was employed in the treatment of all four Plasmodium species: in 177 patients infected by P falciparum (77.6%), 14 with P vivax (29.2%), 1 with P malariae (100%), 1 with Evodiamine P ovale (11.1%), and 3 mixed infections. The analysis of tolerance included 254 patients, thus excluding those who where treated with more than one drug: 34 (19.5%) adverse events were reported in those treated with mefloquine, 29 (76%) in the quinine-treated patients, and 2 (4.7%) in those receiving chloroquine (Figure 1). Cinchonism was registered exclusively in patients treated with quinine; only one patient treated with mefloquine discontinued treatment due to intractable vomiting. Incorrect use of anti-malarial drugs occurred overall in 25 patients (8.6%) in our case file (Table 2); anti-malarial errors were recorded more frequently in patients affected by P vivax malaria (14/48, 29.1%) than in those with P falciparum malaria (9/229, 3.9%; p = 0.0001).