How should I approach the diagnosis of malaria in a patient presenting

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Approach to diagnosis of malaria in a patient with fever after recent travel to a high-risk region:

Take a detailed travel history focusing on recent visits to malaria-endemic areas and timing of symptom onset, as malaria can present up to one year after return.
Consider malaria as a medical emergency, especially if the patient is a child, pregnant woman, elderly (>65 years), or has severe symptoms.
Arrange urgent blood tests for malaria parasites, including thick and thin blood films or rapid diagnostic tests, to confirm diagnosis.
If falciparum malaria is suspected or the species is unidentified, admit the patient immediately for specialist assessment and treatment due to risk of rapid deterioration.
For non-falciparum malaria without severe features, outpatient management may be considered if close clinical and parasitological monitoring is available.
Notify public health authorities of all confirmed malaria cases as it is a notifiable disease.
Advise the patient on the importance of early diagnosis and treatment to prevent progression to severe disease.

Prompt recognition and diagnosis are critical to reduce morbidity and mortality associated with malaria in returning travellers.

References:

How should I approach the diagnosis of malaria in a patient presenting with fever after recent travel to a high-risk region?