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Falciparum malaria evaluation — ABIM Board MCQ

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HardInfectious DiseaseFalciparum malaria evaluationABIM Board

A 33-year-old man returns from Nigeria with confusion, jaundice, creatinine 3.0 mg/dL and Plasmodium falciparum parasitemia of 7%. Blood pressure is stable and oral absorption is uncertain. Which treatment should be initiated?

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

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Correct answer: D — Start intravenous artesunate urgently while arranging follow-on oral therapy

The best answer is “Start intravenous artesunate urgently while arranging follow-on oral therapy”. Neurologic dysfunction, acute kidney injury and parasitemia at this level establish severe malaria. Intravenous artesunate should be started urgently through the appropriate US access pathway, followed by a complete oral regimen when parasite burden has fallen and oral therapy is tolerated. Confirmation and serial smears must not delay treatment.

Reference: CDC Treatment of Severe Malaria: https://www.cdc.gov/malaria/hcp/clinical-guidance/treatment-of-severe-malaria.html