Efficacy and safety of quinine-artesunate in an HIV-positive patient with severe falciparum malaria.

Severe falciparum malaria is a medical emergency that is associated with a high rate of mortality even when treated in an Intensive Care Unit. Until recently intravenous quinine was the standard treatment; however artemisin derivatives are now regarded as the first-line treatment for multidrug-resistant falciparum malaria. Although several studies have demonstrated the superiority of Artesunate this drug is not licensed in many countries. This article describes the case of an HIV-positive patient who returned from Africa and presented with 10% parasitemia and clinical signs of severe falciparum malaria; this individual was successfully treated with a combination of artesunate and quinine. Artesunate was imported from the foreign market and written consent for its administration was obtained in advance. Parasite clearance was rapidly achieved; however on day IV the patient developed acute respiratory distress syndrome that required mechanical ventilation. The patient was extubated on day XIV and discharged on day XXV. Due to its rapid action artesunate was likely responsible for the good clinical outcome in this case; however in order to clarify the role of this new combination therapy further studies are required.