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Suspected imported malaria in pregnancy — MSRA MCQ

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HardInfectious DiseasesSuspected imported malaria in pregnancyMSRA

A 31-year-old woman who is 18 weeks pregnant presents to her GP with 24 hours of fever, rigors, headache, myalgia and two loose stools. She returned 12 days ago from a 3-week visit to relatives in rural Ghana. She reports taking her prescribed malaria chemoprophylaxis throughout travel and since returning. Her temperature is 38.6°C, pulse 104 beats/minute, blood pressure 112/68 mmHg, respiratory rate 18 breaths/minute and oxygen saturation 98% on air. She is alert, drinking and has no rash, neck stiffness, respiratory symptoms or focal abdominal tenderness. A malaria rapid diagnostic test performed in the practice is negative. The practice laboratory courier has left; a malaria blood film sent from the surgery would not be processed until tomorrow morning. The nearest emergency department can obtain and report malaria microscopy immediately. Which is the most appropriate management now?

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

Reveal the answer and explanation

Correct answer: A — Refer her to the emergency department now for urgent malaria blood films and specialist assessment

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

This is suspected imported malaria, which is a medical emergency. Fever after return from the tropics should be managed as malaria until proven otherwise, and urgent blood-film microscopy is required; a negative rapid diagnostic test (RDT) does not exclude malaria. Pregnancy increases the risk of severe malaria and can make diagnosis more difficult because falciparum parasites may be sequestered in the placenta despite negative peripheral films. She therefore requires immediate assessment where urgent thick and thin films, repeat testing if necessary, monitoring and specialist input are available. ([gov.uk](https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/diagnosis?utm_source=openai)) A is unsafe because an RDT cannot replace microscopy. B underestimates the time-critical possibility of falciparum malaria; gastrointestinal symptoms do not make malaria less likely. D causes an avoidable overnight delay: UK guidance specifies that an urgent suspected-malaria sample should reach the laboratory within 1 hour. E is inappropriate when urgent diagnostic testing is available; antimalarial treatment should follow prompt expert assessment and confirmation where possible. Reported adherence to chemoprophylaxis reduces risk but does not safely exclude malaria.

Reference: UK Malaria Expert Advisory Group: 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 UK Malaria Expert Advisory Group: Malaria prevention guidelines for travellers from the UK 2026 — Special risk groups (Updated 16 July 2026) — https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/special-risk-groups UKHSA: Malaria imported into the UK: 2023 (2024) — https://www.gov.uk/government/publications/malaria-in-the-uk-annual-report/malaria-imported-into-the-uk-2023