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Suspected imported malaria — MSRA MCQ

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HardInfectious DiseasesSuspected imported malariaMSRA

A 38-year-old woman presents to general practice on a Friday afternoon with fever, headache, myalgia and two episodes of diarrhoea. She returned to the UK 12 days ago after 2 weeks visiting relatives in rural Sierra Leone. She reports several mosquito bites despite using a bed net. She took atovaquone/proguanil daily from 2 days before travel until 7 days after leaving Sierra Leone, without missed doses or vomiting. She has no significant medical history. Her temperature is 38.4°C, pulse 102 beats/minute, BP 116/70 mmHg, respiratory rate 18 breaths/minute and oxygen saturation 99% on air. She is alert and has no focal signs of infection. The practice laboratory cannot process malaria samples urgently; the emergency department is 20 minutes away. What is the most appropriate management today?

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Correct answer: B — Arrange immediate emergency-department assessment for urgent malaria testing, including blood film microscopy, and communicate suspected malaria to the receiving team

This patient requires immediate assessment for suspected malaria. She has an acute febrile illness within 3 months of return from tropical Africa, where falciparum malaria is a key concern. UK guidance states that fever after return from the tropics should be considered malaria until proven otherwise, that suspected malaria is a medical emergency, and that diagnostic blood films should be obtained urgently. Falciparum malaria can deteriorate over hours; microscopy cannot be deferred until a fever spike or routine laboratory session. Adherence to atovaquone/proguanil reduces risk but does not exclude malaria, so option A is unsafe. Option D introduces an unacceptable delay. Option E may identify thrombocytopenia or hepatic involvement but does not replace urgent parasitological diagnosis and should not delay referral. Option C is inappropriate because malaria cannot be diagnosed clinically with certainty, treatment depends on species and severity, and community empirical treatment could delay definitive assessment. The absence of hypotension, impaired consciousness or respiratory compromise means ambulance transfer is not specified by the stem, but she should be sent directly for same-day emergency assessment rather than managed in routine primary care.

Reference: Malaria prevention guidelines for travellers from the UK 2026: Diagnosis (Updated 16 July 2026) — https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/diagnosis Malaria: migrant health guide (2014) — https://www.gov.uk/guidance/malaria-migrant-health-guide