An 87 yo M brought in by son for complaints of generalized weakness\/ malaise with intermittent “shaking” for 2-3 weeks prior to admission with history of returning from Liberia (West Africa) about 7 days ago after visiting family there. Labs notable for anemia with hyperbilirubinemia\/ mild hemolysis with mild liver dysfunction and postive blood smears for Plasmodium Falciparum. PCP had prescribed him malaria prophylaxis with atovaquone-proguanil (unclear if was taking consistently).<\/p>\n
Due to high clinical suspicion leading to prompt diagnosis, he was appropriately treated with artemether-lumefantine and recovered promtly without\u00a0any complications.<\/p>\n
Teaching points:<\/p>\n
– prophylaxis needs be started 2-3 days prior to departure and continued for at least 7 days after return from endemic area (as the asymptomatic liver\/ exoerythrocytic phase can persist for long time)<\/p>\n
– suspect Malaria when patient presents with high fever (esp with rigors and cyclical nature)\u00a0with hx of recent visit to an endemic malaria area<\/p>\n
– understanding of the lifecycle is essential to understand pathophysiology and management rationale<\/p>\n
– most malaria endemic areas are chloroquine-resistant and artemisinin derivatives with an addl agent like\u00a0lumefantine is first line<\/p>\n
– complications can be severe: encephalopathy, renal and\u00a0hepatic failure, DIC with coagulopathy are a few to watch out for.<\/p>\n