A 35-yr-old woman returns from a journey to Gambia with fevers of 39°C, rigors, vomiting and diarrhoea. She took chloroquine and proguanil prophylaxis. Her oxygen saturations are 90% on air, pulse 120 bpm, BP 80/60 mmHg.
What is the most likely diagnosis?
A. Malaria
B. Typhoid
C. Gastroenteritis GE
D. Atypical pneumonia
E. Pneumococcal pneumonia
Answer:
A. Malaria
Discussion: Malaria is the most likely diagnosis. Although she could also have the other infections, malaria is the most common in travelers returning from West Africa. Malaria always presents with history of fever but it may also present with diarrhea, which is commonly underestimated in emergency as being due to Gastroenteritis.
Pts with high fevers and diarrhoea should be considered to have sepsis until proven otherwise.
She is likely to have developed ARDS, so caution with intravascular filling is important in order
to avoid exacerbating this. She may well require inotropic support.
As the other infections are also possible and are more common in Pts with malaria – due to the
production of an antigenic smoke screen, resulting in immunosuppression secondary to
diversion of the immune response (nonprotective antibodies produced against a large variety of
antigens) – antibiotics should be commenced as well as quinine.
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