{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T09:58:17Z","timestamp":1777111097733,"version":"3.51.4"},"reference-count":26,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5,3]]},"abstract":"<jats:p>Recently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged. Here we report two cases of delayed hemolytic anemia in a patient with severe falciparum malaria after treatment with oral artemether\u2013lumefantrine (AL). The first patient, a 20-year-old Japanese male student, was diagnosed with falciparum malaria and was administered AL. As having a high parasitemia rate (20.6%) was the only severe malaria criterion met in this case and his general condition was stable, we continued with AL treatment. Despite disappearance of malarial parasites after 4 days of AL administration, a persistent fever remained. On days 13 and 16, a diagnosis of hemolytic anemia was made (lactate dehydrogenase [LDH]: 1,466 U\/L, hemoglobin [Hb]: 7.2 g\/dL). A blood smear at that time revealed no parasites. He recovered naturally from delayed hemolysis. The second patient, a 27-year-old Japanese female student, was diagnosed with falciparum malaria (parasitemia: 4.5%) and treated initially with oral quinine hydrochloride and doxycycline. The following day, parasitemia increased to 7.9% and oral AL was initiated. She was discharged on day 4 after achieving parasite clearance and afebrility. However, on day 5, fever (body temperature &gt; 38\u00b0C) recurred, and on day 11, a diagnosis of hemolytic anemia was made (LDH: 712 U\/L, Hb: 8.8 g\/dL). A follow-up confirmed that her condition improved gradually. AL treatment of severe malaria can cause delayed hemolytic anemia. Patients should be followed up for up to 4 weeks to detect signs of hemolysis and provide appropriate symptomatic treatment.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0460","type":"journal-article","created":{"date-parts":[[2017,2,14]],"date-time":"2017-02-14T01:40:26Z","timestamp":1487036426000},"page":"1185-1189","source":"Crossref","is-referenced-by-count":14,"title":["Development of Delayed Hemolytic Anemia After Treatment with Oral Artemether\u2013Lumefantrine in Two Patients with Severe Falciparum Malaria"],"prefix":"10.4269","volume":"96","author":[{"given":"Yasuhiro","family":"Tsuchido","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fukumi","family":"Nakamura-Uchiyama","sequence":"additional","affiliation":[{"name":"Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan."},{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasumi","family":"Toyoda","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritoshi","family":"Iwagami","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Tochitani","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koh","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naokuni","family":"Hishiya","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taku","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenji","family":"Uno","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukiteru","family":"Ouji","sequence":"additional","affiliation":[{"name":"Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeyuki","family":"Kano","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichi","family":"Mikasa","sequence":"additional","affiliation":[{"name":"Center for Infectious Diseases, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsunehiro","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahide","family":"Yoshikawa","sequence":"additional","affiliation":[{"name":"Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruhiko","family":"Maruyama","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Division of Parasitology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"World Malaria Report","author":"World Health Organization","year":"2009"},{"key":"ref2","series-title":"BMC Infect Dis","first-page":"598","article-title":"Monitoring the efficacy and safety of three artemisinin based-combinations therapies in Senegal: results from two years surveillance","volume":"13","author":"Sylla","year":"2013"},{"key":"ref3","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"5","article-title":"Published reports of delayed hemolytic anemia after treatment with artesunate for severe malaria\u2013worldwide, 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