Malaria is a parasite infection spread by Anopheles mosquitoes in tropical regions, so in the US it shows up in travelers and immigrants. Plasmodium falciparum can turn severe within hours, so any fever after travel to an endemic area needs prompt testing.
Key symptoms
- Fever with chills and sweats, sometimes in cycles
- Headache, muscle aches and fatigue
- Nausea, vomiting or diarrhea
- Symptoms days to months after travel to an endemic area
What you find on exam
- Fever and fast heart rate
- Pale skin or yellow eyes from red cell breakdown
- Enlarged spleen or liver
- Confusion, low blood pressure or fast breathing in severe disease
Tests
- Thick and thin blood smears, repeated every 12 to 24 hours up to three times
- Rapid antigen test alongside the smears
- Percent of infected red cells to grade severity
- Blood count, glucose, kidney and liver function, lactate
Treatment basics
- Uncomplicated falciparum: artemether-lumefantrine or atovaquone-proguanil by mouth
- Severe malaria: IV artesunate in the hospital
- Add primaquine or tafenoquine for P. vivax or P. ovale after G6PD testing
- Treat low blood sugar and fluid problems
- Teach prevention before future travel: prophylaxis and bed nets
Red flags
- Confusion, seizures or decreased consciousness
- Parasite level of 5% or more, severe anemia or kidney failure
- Low blood sugar, breathing trouble or shock
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.