Favorable outcome without corticosteroids during post-artesunate delayed hemolysis with positive direct antiglobulin test in severe imported Plasmodium falciparum malaria, France - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases Année : 2023

Favorable outcome without corticosteroids during post-artesunate delayed hemolysis with positive direct antiglobulin test in severe imported Plasmodium falciparum malaria, France

Olivier Paccoud
  • Fonction : Auteur
Xavier Chamillard
  • Fonction : Auteur
Éric Kendjo
Isabelle Vinatier
  • Fonction : Auteur
Laure Surgers
  • Fonction : Auteur
Denis Magne
  • Fonction : Auteur
Benjamin Wyplosz
  • Fonction : Auteur
Adéla Angoulvant
  • Fonction : Auteur
Olivier Bouchaud
  • Fonction : Auteur
Arezki Izri
  • Fonction : Auteur
Sophie Matheron
  • Fonction : Auteur
Sandrine Houzé
  • Fonction : Auteur
Marc Thellier
  • Fonction : Auteur
Alioune P. Ndour
  • Fonction : Auteur
Pierre A. Buffet
  • Fonction : Auteur
Éric Caumes
  • Fonction : Auteur

Résumé

OBJECTIVES: Positive direct antiglobulin tests (DATs) have been reported in cases of post-artesunate delayed hemolysis (PADH), but the causal role of auto-immune hemolysis remains unclear. We aimed to analyze a cohort of patients with PADH and DAT during severe malaria. METHODS: We describe PADH and DAT results in a 7-year multi-center retrospective cohort of patients receiving artesunate for severe imported malaria. RESULTS: Of 337 patients treated with artesunate, 46 (13.6%) had at least one DAT result within 30 days of treatment initiation, and 25/46 (54.3%) had at least one positive DAT. Among 40 patients with available data, 17 (42.5%) experienced PADH. Patient characteristics were similar for patients with a positive or negative DAT, and DAT positivity was not associated with PADH occurrence (P = 0.36). Among patients, 5/13 (38.5%) with a positive DAT after day 7 experienced PADH, compared to 10/13 (76.9%) of those with a negative DAT after day 7 (P = 0.11). Overall, 41% of patients required blood transfusions, and outcome was favorable without corticosteroids, even in cases of PADH. CONCLUSIONS: DAT does not appear to be a marker of PADH, but rather an indirect marker of an immune-mediated mechanism. DAT positivity should not lead to the administration of systemic corticosteroids during PADH. Copyright
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hal-04342562 , version 1 (21-12-2023)

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Olivier Paccoud, Xavier Chamillard, Éric Kendjo, Isabelle Vinatier, Laure Surgers, et al.. Favorable outcome without corticosteroids during post-artesunate delayed hemolysis with positive direct antiglobulin test in severe imported Plasmodium falciparum malaria, France. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2023, 137, pp.144-148. ⟨10.1016/j.ijid.2023.10.018⟩. ⟨hal-04342562⟩
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