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Severe falciparum malaria — DTM&H MCQ

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EasyMalariaSevere falciparum malariaDTM&H

A 45-year-old woman presents to a London tropical diseases unit 10 days after returning from Papua New Guinea. She has fever, confusion, and jaundice. Blood film reveals P. falciparum with 12% parasitaemia. Her creatinine is 320 µmol/L, bilirubin 85 µmol/L, and glucose 2.1 mmol/L. What is the most appropriate treatment?

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Correct answer: D — Intravenous artesunate followed by a full course of artemether-lumefantrine

This patient meets WHO criteria for severe malaria (parasitaemia >10%, renal impairment, cerebral involvement, hypoglycaemia, jaundice). IV artesunate is first-line for severe falciparum malaria, superior to IV quinine as shown in the SEAQUAMAT and AQUAMAT trials. After IV artesunate, a full oral ACT completes treatment. Oral therapies are inappropriate in severe disease due to unreliable absorption. Chloroquine is ineffective against falciparum in Papua New Guinea.

Reference: WHO Guidelines for Malaria 2022; SEAQUAMAT and AQUAMAT trials