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Suspected malaria in a returning traveller — MRCEM SBA MCQ

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EasyInfection and sepsisSuspected malaria in a returning travellerMRCEM SBA

A 34-year-old man presents to the emergency department with two days of fever, rigors and headache. He returned from Ghana 12 days ago. His temperature is 39.0°C, pulse 104/min, blood pressure 124/76 mmHg and respiratory rate 18/min. He is alert, and examination identifies no source of infection. His platelet count is 92 × 10⁹/L. An urgent malaria blood film and rapid diagnostic test are both negative, but he remains febrile. What is the most appropriate management plan?

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Correct answer: C — Admit and examine blood films daily for three days while investigating other causes.

Recent travel from Ghana and unexplained ongoing fever sustain concern for malaria despite the two negative initial tests. A single negative blood film or rapid diagnostic test does not exclude malaria. UKHSA advises examining blood films daily for three days when suspicion persists, while also considering other diagnoses. Admission provides continued assessment for this persistently febrile patient; it is not a requirement that every patient undergoing serial films remain in hospital. ([gov.uk](https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/diagnosis)) A gives the first negative results too much weight and delays reassessment. B offers serial testing, but rapid tests supplement rather than replace microscopy in UK practice. D retains microscopy but unnecessarily waits for fever spikes: sampling need not coincide with a spike, and waiting can delay diagnosis. E would prioritise treatment over the indicated diagnostic assessment despite the absence of features suggesting severe malaria in this patient. If the daily films are negative and suspicion remains, seek tropical or infectious diseases specialist advice. ([gov.uk](https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/diagnosis))

Reference: Malaria prevention guidelines for travellers from the UK 2026: Diagnosis (31 July 2026) — https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/diagnosis