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Severe falciparum malaria — DTM&H MCQ

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EasyMalariaSevere falciparum malariaDTM&H

A 42-year-old woman presents 10 days after returning from Sierra Leone with confusion, jaundice and oliguria. Blood film shows Plasmodium falciparum with 7% parasitaemia and metabolic acidosis. What is the most appropriate treatment?

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Correct answer: B — Intravenous artesunate

Intravenous artesunate is the single best answer because impaired consciousness, acidosis, renal injury and high parasitaemia indicate severe falciparum malaria requiring parenteral artesunate. Oral atovaquone-proguanil is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that treatment should not be delayed while arranging transfer or repeat films.

Reference: WHO Guidelines for malaria, 2025; UKHSA Malaria prevention guidelines for travellers from the UK, 2025; CDC Yellow Book 2026