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Case Reports
. 2017 Aug 15:32:37-40.
doi: 10.1016/j.phymed.2017.04.006. Epub 2017 Apr 14.

Artemisia annua dried leaf tablets treated malaria resistant to ACT and i.v. artesunate: Case reports

Nsengiyumva Bati Daddy  1 , Luc Malemo Kalisya  2 , Pascal Gisenya Bagire  3 , Robert L Watt  4 , Melissa J Towler  5 , Pamela J Weathers  6
Affiliations
Case Reports

Artemisia annua dried leaf tablets treated malaria resistant to ACT and i.v. artesunate: Case reports

Nsengiyumva Bati Daddy et al. Phytomedicine. .

Abstract

Background: Dried leaf Artemisia annua (DLA) has shown efficacy against Plasmodium sp. in rodent studies and in small clinical trials. Rodent malaria also showed resiliency against the evolution of artemisinin drug resistance.

Purpose: This is a case report of a last resort treatment of patients with severe malaria who were responding neither to artemisinin combination therapy (ACT) nor i.v. artesunate.

Study design: Of many patients treated with ACTs and i.v. artesunate during the 6 mon study period, 18 did not respond and were subsequently treated with DLA Artemisia annua.

Methods: Patients were given a dose of 0.5g DLA per os, twice daily for 5d. Total adult delivered dose of artemisinin was 55mg. Dose was reduced for body weight under 30kg. Clinical symptoms, e.g. fever, coma etc., and parasite levels in thick blood smears were tracked. Patients were declared cured and released from hospital when parasites were microscopically undetectable and clinical symptoms fully subsided.

Results: All patients were previously treated with Coartem® provided through Santé Rurale (SANRU) and following the regimen prescribed by WHO. Of 18 ACT-resistant severe malaria cases compassionately treated with DLA, all fully recovered. Of the 18, this report details two pediatric cases.

Conclusions: Successful treatment of all 18 ACT-resistant cases suggests that DLA should be rapidly incorporated into the antimalarial regimen for Africa and possibly wherever else ACT resistance has emerged.

Keywords: ACT; Artemisia annua; Artemisinin drug resistance; Coartem; Dihydroartemisinin; Synergism.

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Conflict of interest statement

Competing interests.

We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Figures

Figure 1
Figure 1
TLC fingerprint of methanol (MeOH) and methylene chloride (MeCl2) extracts of the Anamed A-3 Ethiopian grown Artemisia annua dried leaf tablets used in the study. Lane identification: 1: MeCl2 extract of DLA tablet powder (2 mg); 2: MeOH extract (2 mg); 3: artemisinin standard (5 µg); 4: MeCl2 extract; 5: MeOH extract; 6: (top to bottom) chrysoplenetin, chrysoplenol-D, chlorogenic acid standards (10 µg). Left photo, unstained TLC under UV illumination; middle photo, p-anisaldehyde stain under visible light; right photo, aluminum chloride stain under UV illumination.
Figure 2
Figure 2
ACT and i.v. artesunate failure cases out of thousands of successfully ACT-treated malaria cases over 6 months in 2016 in North Kivu province, Democratic Republic of Congo.
See this image and copyright information in PMC

References

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