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Patient case: Malaria

Patient case: Malaria

Discussion

A 32-year-old male presents to the emergency department with a three-day history of intermittent fever, chills, headache, and muscle aches. He also reports nausea and a mild episode of vomiting. His symptoms began approximately two weeks after returning from a business trip to a tropical region.

On examination, he appears fatigued, with a temperature of 39.2°C (102.6°F), mild tachycardia, and mild pallor. There is no rash, but he has slight hepatosplenomegaly. Initial laboratory tests reveal anemia, mild thrombocytopenia, and elevated liver enzymes. A rapid diagnostic test and thick blood smear confirm the presence of Plasmodium falciparum parasites.

He is admitted for intravenous antimalarial therapy and supportive care, including hydration and fever management. His symptoms begin to improve within 48 hours, and after a full course of treatment, he is discharged with instructions on malaria prevention for future travel.

Questions
1. What is the most likely cause of this patient’s symptoms?

a) Dengue fever

b) Typhoid fever

c) Malaria

d) Leptospirosis

2. Which test is most useful for confirming the diagnosis of malaria?

a) Blood culture

b) Thick blood smear

c) Chest X-ray

d) Urinalysis

3. What is the most likely causative organism in this patient’s case?

a) Plasmodium vivax

b) Plasmodium falciparum

c) Plasmodium malariae

d) Plasmodium ovale

4. What is the best initial management for this patient?

a) Oral antibiotics

b) Intravenous antimalarial therapy

c) Corticosteroids

d) Supportive care only

Reveal answers

Answers

1. Answer: c) Malaria

The patient's history of travel to a tropical region, along with fever, chills, and hepatosplenomegaly, strongly suggests malaria. Other options, like typhoid and dengue, do not typically present with the same pattern of symptoms.

2. Answer: b) Thick blood smear

A thick blood smear is the gold standard for malaria diagnosis, as it allows for the detection and quantification of Plasmodium parasites in red blood cells. Rapid diagnostic tests can be useful but may not always differentiate species.

3. Answer: b) Plasmodium falciparum

P. falciparum is the most severe form of malaria and is commonly found in tropical regions. It is associated with complications like severe anemia, cerebral malaria, and multi-organ dysfunction.

4. Answer: b) Intravenous antimalarial therapy

Given the severity of the patient’s symptoms, IV antimalarial therapy is the best choice to rapidly clear the parasite load. Supportive care, including fluids and fever management, is also essential.