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Fever in returning traveler — ABIM Board MCQ

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HardInfectious DiseaseFever in returning travelerABIM Board

A 33-year-old returns from Nigeria with fever, rigors, headache, thrombocytopenia and splenomegaly after taking no prophylaxis. What diagnostic testing is required urgently?

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Correct answer: D — Obtain stat thick and thin smears, repeating if negative

The best answer is “Obtain stat thick and thin smears, repeating if negative”. Thick smear is sensitive for parasites, while thin smear identifies species and quantifies parasitemia; both must be read urgently. In a nonimmune traveler, low initial parasitemia can yield a negative smear, so repeat testing every 12 to 24 hours for three sets when suspicion persists. Serology, stool testing and a lone rapid test are inadequate.

Reference: CDC Malaria Evaluation and Diagnosis Guidance: https://www.cdc.gov/malaria/hcp/clinical-guidance/evaluation-diagnosis.html