Rezumat
Background: Severe malaria affects several haematological and biochemical parameters with vast clinical manifestations which may lead to death. However, the rate at which these respond to
artesunate/artemether-lumefantrin combination therapy as monitoring tools for therapeutic response and recovery in children with severe malaria is not documented.
Objective: The aim of the study was to determine the responses of selected haematological andbiochemical parameters to artesunate/artemether-lumefantrin combination therapy in children with severe malaria with the goal of identifying parameters with very fast response for early monitoring of therapeutic response and recovery.
Materials and methods: The level of selected haematological parameters [haemoglobin (Hb), packed cell volume (PCV), total leucocytes (TWBC), neutrophils (N), lymphocytes (L), monocytes (M), eosinophils (E), basophils (B) and platelets (P)] and serum level or activity of some biochemical parameters [malondialdehyde (MDA), protein carbonyls (PCO), nitric oxide (NO), glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPx), vitamins A, C, and E, C-reactive proteins (CRP), bicarbonate (HCO3 - ) and glucose] were measured using standard methods in 100 children (1-10 years) with severe malaria before treatment (day 0), 48 hours of treatment (day 2) and 48 hours after treatment (day 7) according to WHO recommended dosage of artesunate/ artemether-lumefantrin combination therapy, using 200 clinically healthy children as control.
Results: Eosinophils, monocytes, basophils, HCO3 - , PCO/SOD, CRP/SOD and HCO3 - /glucose in case children were normalised during treatment (day 2) indicating fastest response while the level or activity of TWBC, N, L, SOD, GR, GPx and glucose was normalised after treatment (day 7) depicting fast response. The level or activity of PCV, Hb, P, MDA, PCO, NO, CAT, GSH, vitamins A, C, E and CRP in case children were significantly different (p<0.05) compared to control after treatment (day 7) indicating slow response.
Conclusion: This study showed that eosinophils, monocytes, basophils, HCO3 - , PCO/SOD, CRP/SOD and HCO3 - /glucose have the fastest responses to treatment in severe malaria, and may be used as additional parameters for early monitoring of therapeutic response in children with the disease.
Keywords: Severe malaria, haematological and biochemical parameters, monitoring, children, Artesunate-lumefantrine combination
Résumé
Contexte: Le paludisme sévère affecte plusieurs paramètres hématologiques et biochimiques avec de nombreuses manifestations cliniques pouvant entraîner à la mort. Cependant, le taux auquel ils répondent à la thérapie combinée par l’artésunate/artéméther-lumefantrine comme outils de surveillance pour la réponse thérapeutique et le rétablissement chez les enfants atteints du paludisme grave n’est pas documenté.
Objectif: Le but de l’étude était de déterminer les réponses de certains paramètres hématologiques et biochimiques à la thérapie combinée d’artésunate/arteméther-lumefantrine chez les enfants atteints du paludisme sévère dans le but d’identifier des paramètres avec une réponse très rapide pour un suivi hâtif de la réponse thérapeutique et de la récupération.
Matériaux et méthodes: Le niveau de paramètres hématologiques sélectionnés [hémoglobine (Hb), volume cellulaire emballé (PCV), leucocytes totaux (TWBC), neutrophiles (N), lymphocytes (L),
monocytes (M), éosinophiles (E), basophiles (B) et les plaquettes (P)] et le niveausérique ou l’activité de certains paramètres biochimiques [malondialdéhyde (MDA), protéines carbonylées (PCO), oxyde nitrique (NO), glutathion (GSH), super-oxyde dismutase (SOD), catalase (CAT ), La glutathion réductase (GR), la glutathion peroxydase (GPx), les vitamines A, C et E, les protéines C-réactives (CRP), le bicarbonate (HCO3 -) et le glucose] ont été mesurées en utilisant des méthodes standard chez 100 enfants (1-10 ans) avec un paludisme grave avant traitement (jour 0), 48 heures de traitement (jour 2) et 48 heures après traitement (jour 7) selon la posologie recommandée par l’OMS pour la thérapie combinée avec l’artésunate/artéméther-lumefantrine, en utilisant 200 enfants cliniquement sains comme témoins .
Résultats: Eosinophiles, monocytes, basophiles, HCO3 -, PCO/SOD, CRP/SOD et HCO3 -/glucose dans le cas où les enfants étaient normalisés pendant le traitement (jour 2) indiquant la réponse la plus rapide alors que le niveau ou l’activité de TWBC, N, L, SOD , GR, GPx et glucose ont été normalisés après traitement (jour 7) représentant une réponse rapide. Le niveau ou l’activité de PCV, Hb, P, MDA, PCO, NO, CAT, GSH, vitamines A, C, E et CRP dans le cas où les enfants étaient significativement différents (p <0,05) par rapport au contrôle après traitement (jour 7) indiquant réponse lente.
Conclusion: Cette étude a montré que les éosinophiles, les monocytes, les basophiles, le HCO3 -, PCO/SOD, CRP/SOD et HCO3-/glucose ont les réponses les plus rapides au traitement contre le paludisme sévère et peuvent être utilisés comme paramètres supplémentaires pour le suivi hâtif de la réponse thérapeutique chez les enfants atteints de la maladie.
Mots-clés: Paludisme sévère, paramètres hématologiques et biochimiques, surveillance, enfants, combinaison Artesunate-Lumefantrine
Correspondence: Dr. C.A. Okoli, Department of Paediatrics, Faculty of Medical Sciences, University of Jos, Jos, Nigeria. Email: caroalph@yahoo. com
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