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Severe falciparum malaria — SCE Acute Medicine MCQ

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HardInfectious diseasesSevere falciparum malariaSCE Acute Medicine

A 32-year-old man presents with fever, jaundice and confusion after returning from Nigeria 10 days ago. Platelets are 38 × 10^9/L, bilirubin 72 micromol/L and creatinine 184 micromol/L. Malaria rapid diagnostic test is positive and thick film shows Plasmodium falciparum parasitaemia of 6%. What is the most appropriate next step in management?

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Correct answer: E — Admit urgently and start intravenous artesunate

Confusion, renal impairment, jaundice, thrombocytopenia and high parasitaemia indicate severe falciparum malaria. The appropriate treatment is urgent inpatient IV artesunate with specialist infectious diseases input. Oral therapy is for uncomplicated malaria; chloroquine resistance makes it inappropriate for falciparum acquired in most endemic areas.

Reference: UKHSA Malaria Treatment Guidelines; BNF