SHM Converge Scientific Abstract ePoster Gallery-A Case of Severe P. Falciparum Malaria 5 Years After Travel to an Endemic Region

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This document describes a rare case of severe <em>Plasmodium falciparum</em> malaria presenting in a 41-year-old man in the United States, five years after his last travel to an endemic region. Malaria is caused by <em>Plasmodium</em> parasites and transmitted by female <em>Anopheles</em> mosquitoes; most U.S. cases are imported, with local transmission now extremely rare.

The patient presented with three days of fever, chills, headache, and vomiting. He had recent travel within the U.S. and the UK, but only remote travel to East Africa, China, and Chile in 2016. His exam showed fever and hepatosplenomegaly, and labs revealed hemolytic anemia, leukopenia, thrombocytopenia, and mixed hyperbilirubinemia. A peripheral smear showed intra-erythrocytic ring forms, initially raising concern for <em>Babesia</em> versus <em>Plasmodium</em>. Because of recent travel to New England, he was first treated with atovaquone and azithromycin for babesiosis. However, his condition worsened on day 2, with disorientation, jaundice, and pancytopenia, so atovaquone-proguanil was added for presumed malaria. CDC testing later confirmed <em>P. falciparum</em> and ruled out <em>Babesia</em>.

The patient improved clinically by day 5, with better mentation, blood counts, and bilirubin levels, and was discharged on hospital day 6. He remained well at follow-up three weeks later.

The discussion highlights that this case is unusual because of the long delay between travel to an endemic area and symptom onset. Possible explanations include chronic low-level infection with parasites persisting in the spleen or bone marrow, or “airport malaria” from infected mosquitoes transported by airplane. The key takeaway is that <em>P. falciparum</em> malaria can present long after exposure, so early confirmatory testing is important when the clinical picture suggests malaria.

Asset Subtitle

Andrew Faturos

Meta Tag

Author List Abu Baker Sheikh, Andrew Faturos, Mark Lacy, Suman Pal

Category Clinical Vignettes

Concept Malaria

Concept Plasmodium

Concept Plasmodium falciparum

Concept Mosquito vector

Concept Peripheral Blood Smear

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Andrew Faturos

Track Adult

Keywords

Plasmodium falciparum

malaria

severe malaria

United States

delayed presentation

hemolytic anemia

thrombocytopenia

hepatosplenomegaly

Babesia differential

CDC confirmation

Malaria

Plasmodium

Plasmodium falciparum

Mosquito vector

Peripheral Blood Smear