Ataxia and Slurred Speech after Artesunate Treatment for Falciparum Malaria

Abstract

A 36-year-old US geologist, who purchased a pack of artesunate tablets (manufactured in China) in Ghana in July 1996 following fever and chills and a blood smear positive for Plasmodium falciparum, noticed his gait becoming unsteady 2 days after completing the 5-day artesunate treatment (2 tablets on day one, then one tablet daily). He became afebrile on day 2 of treatment, and a blood smear on day 5 contained no malaria parasites. During the next week worsening ataxia and slurred speech developed. Magnetic resonance imaging of the brain and a lumbar puncture at a hospital in London, UK, revealed no abnormalities and he returned to California, USA. In September 1996 the patient was admitted to a southern California hospital with persistent neurological symptoms. A peripheral smear was positive for Plasmodium sp. and the patient was treated with oral quinine and doxycycline. Rehabilitation therapy moderately improved the ataxia and almost completely resolved his slurred speech by November 1996. The correspondents warn of the possible neurotoxic side effects of artemisinin compounds.