Background: In 2012-2013, a pilot study on implementation
of community-based case malaria management by trained community health workers
was implemented in southern Katanga Province in the Democratic Republic of
Congo (DRC). We report one case of severe adverse reaction that was linked to
artesunate-amodiaquine (ASAQ). Case summary: An apparent healthy, 15-year-old
Congolese female with a positive rapid diagnostic test for Plasmodium falciparum without any sign of complications was
prescribed a fixed dose combination of ASAQ. Under direct observation, she took
two tablets of ASAQ (200 mg
AS/540mg AQ total) with water. Approximately 30 minutes later, she developed a
generalized pruritus and widespread urticarial rash, with marked periorbital
and forearm swelling. She was immediately referred to the nearest clinic. She
did not present with fever or any respiratory distress and was fully conscious.
She received dexamethasone 8 mg IV, followed 20 min later by 4 mg of chlorphenamine
orally. Approximately 40 minutes after, the rash and swellings had mostly resolved.
She received oral quinine as a second line treatment. Conclusion: This single
presentation was the only such occurrence from 1354 malaria-infected patients.
As ASAQ is the most widely used first-line treatment in the DRC, increased
awareness and close monitoring of the use of this drug are advised. Health care professionals should document,
report and provide immediate medical assistance.
Cite this paper
Swana, E. K. , Katshiza, C. , Luboya, O. N. and Bangs, M. J. (2017). Severe Allergic Reaction to Oral Artesunate-Amodiaquine Combination Treatment for Malaria: Case Report in the Democratic Republic of Congo. Open Access Library Journal, 4, e3676. doi: http://dx.doi.org/10.4236/oalib.1103676.
Ruizendaal, E., Dierickx, S., Grietens, K.P., Schallig, H.D., et al. (2014) Success
or Failure of Critical Steps in Community Case Management of Malaria with Rapid
Diagnostic Tests: A Systematic Review. Malaria
Journal, 13, 229. https://doi.org/10.1186/1475-2875-13-229
Ribeiro, I.R. and Olliaro, P.
(1998) Safety
of Artemisinin and Its Derivatives. A Review of Published and Unpublished
Clinical Trials. Médecine Tropicale, 58, 50-53.
Price, R.,
Vugt, V., Phaipun, L.,
Luxemburger, C., et al. (1999) Adverse
Effects in Patients with Acute Falciparum Malaria Treated with Artemisinin
Derivatives. The American Journal of
Tropical Medicine and Hygiene, 60, 547-555. https://doi.org/10.4269/ajtmh.1999.60.547
Swana, E.K., Makan, G.Y., Mukeng, C.K., Mupumba, H.I., Kalaba, G.M., Luboya, O.N. and Bangs, M.J. (2016) Feasibility and Implementation
of Community-Based Malaria Case Management with Integrated Vector Control in
the Democratic Republic of Congo. Malaria
Journal, 15, 413. https://doi.org/10.1186/s12936-016-1475-3
Adjuik, M., Agnamey, P., Babiker, A.,
Borrman, S., et al. (2002) Amodiaquine-Arte- sunate
versus Amodiaquine for Uncomplicated Plasmodium
falciparum Malaria in African Children: A Randomised, Multicentre Trial. Lancet, 359,
1365-1372. https://doi.org/10.1016/S0140-6736(02)08348-4
Hatton, C.S.R., Peto, T.E.A., Bunch, C.
and Pasvol, G.
(1986) Frequency
of Severe Neutropenia Associated with Amodiaquine Prophylaxis against Malaria. Lancet, 1, 411-414. https://doi.org/10.1016/S0140-6736(86)92371-8
Leonardi, E., Gilvary, G., White, N.J.
and Nosten, F.
(2001) Severe
Allergic Reactions to Oral Artesunate: A Report of Two Cases. Transactions of the Royal Society of
Tropical Medicine and Hygiene, 95, 182-183. https://doi.org/10.1016/S0035-9203(01)90157-9
Ndounga, M., Mayengue, P.I., Casimiro, P.N.,
Koukouikila-Koussounda, F., et al. (2015) Artesunate-Amodiaquine versus Artemether-Lumefantrine
for the Treatment of Acute Uncomplicated Malaria in Congolese Children under 10
Years Old Living in a Suburban Area: A Randomized Study. Malaria Journal, 14, 423. https://doi.org/10.1186/s12936-015-0918-6
Onyamboko, M.A., Fanello, C.I., Wongsaen, K.,
Tarning, J., et al. (2014) Randomized
Comparison of the Efficacies and Tolerabilities of Three Artemisinin-Based
Combination Treatments for Children with Acute Plasmodium falciparum Malaria in the Democratic Republic
of the Congo. Antimicrobial Agents and
Chemotherapy, 58, 5528-5536.
Egunsola, O.
and
Oshikoya, K.
(2013) Comparative
Safety of Artemether-Lume- fantrine and Other Artemisinin-Based Combinations
in Children: A Systematic Review. Malaria
Journal, 12, 385. https://doi.org/10.1186/1475-2875-12-385
Dodoo, A.N.O., Fogg, C., Nartey, E.T.,
Ferreira, G.L.C., et al. (2014) Profile
of Adverse Events in Patients Receiving Treatment for Malaria in Urban Ghana: A
Cohort-Event Monitoring study. Drug Safety, 6, 433-448. https://doi.org/10.1007/s40264-014-0164-9
Ndounga, M.,
Mayengue, P.I.,
Casimiro, P.N.,
Loumouamou, D., et al. (2013) Artesunate-Amodiaquine
Efficacy in Congolese Children with Acute Uncomplicated Falciparum Malaria in
Brazzaville. Malaria Journal, 12, 53.
