A Man With Fever, Fatigue, and a Trip to Nigeria

Dean M. Sayre, MD, MS


March 04, 2021

Editorial Collaboration

Medscape &

This patient should take chemoprophylaxis when traveling to Nigeria. His recent infection with malaria does not provide him with effective protection against the disease. Although persons living in malaria-endemic areas may develop a semi-immunity to malaria, it quickly wanes when they leave the area to live in a nonendemic area. All people who visit malaria-endemic regions from the United States should be provided with antimalarials.

There are several options for malaria chemoprophylaxis that can be tailored to patient preference and destination. CDC recommendations for sub-Saharan Africa include atovaquone-proguanil, doxycycline, or mefloquine. Of note, artemether-lumefantrine is not used as a prophylactic medication; and chloroquine, once a widely used antimalarial drug, is effective in only a very limited geographic area (not including Nigeria) because of drug resistance.

The RTS,S vaccine is licensed and currently undergoing pilot implementation in three countries in Africa; however, the target population for this vaccine is children in malaria-endemic areas, and it is not yet approved for use in the United States.

Malaria is a preventable and treatable disease, but without recognition and prompt action, it can quickly become life-threatening. Roughly 2000 cases of malaria are reported in returning travelers in the United States every year, with about 300 of them requiring hospitalization and treatment with IV artesunate. Both estimates have consistently trended upward for decades. All travelers returning to the United States from malaria-endemic areas who report or are found to have fever should be immediately tested for malaria.


Algorithm for Management of Malaria

Guidelines for Treatment of Malaria in the United States

Malaria Information and Prophylaxis, by Country

FDA Approval of Artesunate Press Release

DPDx Website for Laboratory Diagnostic Support

Malaria Hotline at CDC for clinical guidance and IV artesunate:

  • (770) 488-7788 M–F 9 AM–5 PM EST

  • (770) 488-7100 after hours and on weekends

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