Abstract
Mentor: Jennifer M. Davis Program: Internal Medicine – Infectious Diseases Type: Case Report Background: Fever in returning international travelers should prompt consideration for endemic and emerging infectious diseases. Early symptoms of malaria are often nonspecific. If diagnosis and therapy are delayed, patients can experience high parasite burden leading to severe disease. Case: A 61-year-old man with no chronic medical conditions presented to the emergency department with 2 days of fever, myalgias, and night sweats after returning from a 2-week trip to Uganda. The patient had gone on safari, went white water rafting, and stayed in hostels. He did not receive any travel-focused vaccines or antimalarial chemoprophylaxis. Laboratory abnormalities included platelet count 35 U/L, white blood count 6.4 U/L with 0% eosinophils, AST 100 U/L, ALT 114 U/L, alkaline phosphatase 139 U/L, total bilirubin 4.1 mg/dL. Peripheral blood smear ( Figure 1) and BioFire® Global Fever Panel were positive for P. falciparum, with initial parasite burden >5%. Given the severity of disease, he was started on IV artesunate. Acquisition of IV artesunate was delayed requiring use of oral therapy. He completed 1.5 doses of IV artesunate and 5 days of artemether-lumefantrine. On follow up, night sweats and urinary frequency prompted testing and subsequent treatment of Schistosoma coinfection. Figure 1 Peripheral blood smear with intracellular ring trophozoites of P. falciparum. Conclusion: Travelers can be exposed to multiple infectious threats in tropical areas, and patients should be evaluated for co-infections. Pre-travel counseling should include offering antimalarial chemoprophylaxis to patients traveling to areas of risk. If IV artesunate is not available for management of severe malaria, treatment with oral antimalarials should be initiated until IV therapy can be obtained.