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Management and treatment of uncomplicated imported malaria in adults. Update of the French malaria clinical guidelines

Abstract : The diagnosis of malaria should always be considered in travelers returning from an endemic area and presenting with fever or a history of fever, either isolated or combined with other general, digestive, and/or respiratory symptoms, even if appropriate chemoprophylaxis was used. • Outpatient management of uncomplicated Plasmodium falciparum malaria may be implemented if precise clinical and biological criteria are met and if medical follow-up is possible. • Admission to hospital is recommended for individuals at risk of complications (young children and elderly, comorbidity, pregnancy, splenectomy, etc.). • The first-line treatment of uncomplicated P. falciparum malaria in adults is an artemisinin-derivative combination therapy (ACT): artemether-lumefantrine or artenimol-piperaquine. When such treatment is unavailable, not tolerated, or contraindicated, if interactions with concomitant medication are possible, or if ACT fails, then treatment with atovaquone-proguanil is an alternative option. Pregnant women (1st trimester) presenting with uncomplicated P. falciparum malaria should be hospitalized and treated with atovaquone-proguanil, or quinine if vomiting occurs. From the 2nd trimester on, priority should be given to artemether-lumefantrine or artenimol-piperaquine. • Uncomplicated malaria caused by species other than P. falciparum (i.e., P. vivax, P. ovale, P. malariae, or P. knowlesi) is treated with chloroquine or ACT. The latter is preferable in cases of co-infection or P. vivax malaria in travelers returning from a region known for resistance to chloroquine. • To prevent relapses in individuals infected with P. vivax or P. ovale, the dormant liver forms must be eliminated using primaquine, for which temporary use authorization (TUA) may be obtained once possible contraindications have been ruled out (glucose-6-phosphate dehydrogenase [G6PD] deficiency, pregnancy, breastfeeding).
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Contributeur : Elisabeth Grelier Connectez-vous pour contacter le contributeur
Soumis le : mercredi 9 octobre 2019 - 15:10:30
Dernière modification le : vendredi 5 août 2022 - 03:36:11

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Loïc Epelboin, Christophe Rapp, Jean François Faucher, Frédéric Méchaï, Emmanuel Bottieau, et al.. Management and treatment of uncomplicated imported malaria in adults. Update of the French malaria clinical guidelines. Médecine et Maladies Infectieuses, 2019, ⟨10.1016/j.medmal.2019.07.011⟩. ⟨hal-02309737⟩



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