Malaria Recurrence Caused by Plasmodium falciparum

Shakoora Omonuwa, MD, Smith Omonuwa, MD, MSc

Disclosures

J Am Board Fam Med. 2002;15(2) 

In This Article

Case Report

A 29-year-old Hispanic man was examined in the emergency department and questioned with the aid of an interpreter. He had not traveled outside United States since his arrival more than 1 year ago. He reported treatment of malaria and dengue fever when he lived in Mexico but had been apparently well until his present illness.

He complained of nausea and vomiting, fever, chills, and anorexia for the previous 4 days. He also complained of headache, dizziness, dark urine, and back pain with muscle aches. The patient's temperature was 101.9°F, pulse 101 beats per minute, respirations 20/min, and blood pressure 110/64 mm Hg. He had orthostatic hypotension, with a supine blood pressure 116/62 mm Hg and a heart rate of 71 beats per minute, which changed to a standing blood pressure of 92/60 mm Hg and tachycardia (101 beats per minute). Abnormal laboratory values were total bilirubin 1.4 mg/dL, a platelet count of 64,000/mL, and amber-colored urine. Microscopic examination of a thick blood film was positive for P falciparum malaria. The patient was given fluids -- 5% dextrose in normal saline -- a prescription for quinine, 650 mg 3 times a day for 5 days, and one treatment course of 5 tablets of mefloquine (250 mg). The patient was released from the emergency department the same day with a confirmed diagnosis of falciparum malaria. Close follow-up examinations were recommended.

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