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Malaria — SCE Infectious Diseases MCQ

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EasyTropical & Imported InfectionsMalariaSCE Infectious Diseases

A 33-year-old traveller returns from the Amazon basin with high fever, jaundice, and dark urine. Thick blood film shows P. vivax. Despite a good clinical response to Chloroquine, he relapses 6 weeks later with a further episode of P. vivax malaria. What additional treatment was likely omitted?

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Correct answer: B — Primaquine 14-day course to eradicate hypnozoites

P. vivax and P. ovale form hypnozoites (dormant liver stages) that can reactivate weeks to months later. Chloroquine treats blood-stage parasites but does not eliminate hypnozoites. A 14-day course of Primaquine (0.25–0.5 mg/kg daily) is required to achieve radical cure. G6PD testing is mandatory before prescribing Primaquine as it causes haemolytic anaemia in G6PD-deficient individuals. Tafenoquine is an alternative single-dose option.

Reference: UKHSA/UKMEAG 2016 – UK malaria treatment guidelines; WHO 2022 – Malaria guidelines