skip to main content

Severe falciparum malaria with cerebral features — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectious diseasesSevere falciparum malaria with cerebral featuresSCE Acute Medicine

Ten days after intravenous artesunate for severe falciparum malaria, a 34-year-old man develops fatigue and jaundice. Parasite films remain negative, haemoglobin has fallen from 112 to 72 g/L, LDH is high, haptoglobin is undetectable and the direct antiglobulin test is negative. What is the most likely explanation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Post-artesunate delayed haemolysis

Delayed haemolysis can occur one to three weeks after parenteral artesunate as once-infected erythrocytes cleared of parasites are subsequently removed from circulation. Parasite films remain negative and the haemolysis is non-immune. Patients treated for severe malaria need follow-up haemoglobin and haemolysis markers; severe symptomatic anaemia may require transfusion.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC7132403/