Abstract
Malaria in the United States is rare and most commonly presents among returning travelers from endemic areas. Diagnosis is classically dependent on a positive blood smear or polymerase chain reaction (PCR) test. The objective of this case report is to highlight a case of suspected malaria in a high-risk individual with negative diagnostic testing where a trial of empiric treatment was initiated based on clinical presentation after a thorough discussion of risks and benefits. However, empiric treatment based on a single case is limiting. We present a case of a 56-year-old man with extensive travel history throughout Asia, who presented after multiple episodes of unprovoked 24-hour fevers over the past seven years. A thorough rheumatologic and infectious inpatient workup was negative and oncology was consulted with low suspicion for malignancy. However, based on clinical presentation and history, malaria remained highly suspected and an empiric trial of anti-malarial treatment was initiated. One year after receiving treatment, the patient has not experienced any further febrile episodes. The efficacy of blood smears and PCR may be influenced by the malarial strain, as some species have low circulating biomass. Therefore, blood smears and PCR testing may not always be diagnostic. Clinical signs supportive of a malarial infection include fever, rigors, chills, hepato/splenomegaly, hyperbilirubinemia, and thrombocytopenia. Malaria is endemic to many regions outside of Africa, including Asia, and should be considered in any returning traveler with recurrent fevers.
Highlights
Malaria is a common cause of recurring fevers and is recognized to have high endemicity in subSaharan Africa and parts of Asia
Some species of Plasmodium are less detectable in peripheral blood, and negative blood smears do not rule out the diagnosis [2,3]
The anemia was resolving with a hemoglobin of 13.3 g/dL; thrombocytopenia fully resolved with a platelet count of 169 B/L
Summary
Malaria is a common cause of recurring fevers and is recognized to have high endemicity in subSaharan Africa and parts of Asia. Malaria is common outside of Africa and presents but has distinct clinical differences. Blood smears with Giemsa stain are the gold standard for diagnosis [1]. Some species of Plasmodium are less detectable in peripheral blood, and negative blood smears do not rule out the diagnosis [2,3]. A 56-year-old man presented to the emergency department (ED) after experiencing a fever to 101°F (38.3°C) at home. His past medical history included intermittent febrile episodes over the past seven years and hypertension.
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