SHM Converge Scientific Abstract ePoster Gallery-Glaring Malaria: Considerations for Identifying and Treating Relapsed Malaria

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This case describes a 58-year-old man with major neurologic disability who was admitted with fever, cough, secretions, and sepsis-like symptoms. Initial workup, including cultures and imaging, did not identify a clear source of infection, and he continued to have cyclic fevers despite broad-spectrum antibiotics. On hospital day 5, a blood smear incidentally revealed parasitized red blood cells consistent with non-falciparum malaria, most likely <em>Plasmodium vivax</em>.

The case highlights important considerations in diagnosing and treating relapsed malaria. In patients with a prior history of <em>P. vivax</em> or <em>P. ovale</em> infection, relapse should remain in the differential diagnosis for any new febrile illness, even months later. Treatment selection was complicated by medication interactions and resistance patterns: artemether-lumefantrine was avoided because the patient was taking rifampin for latent TB, which reduces its effectiveness; chloroquine was not appropriate because of resistance in Ethiopia, the likely region of acquisition. High-dose atovaquone-proguanil was used for the acute blood-stage infection, and parasitemia cleared after four days despite rifampin-related metabolic concerns.

To prevent future relapse from dormant liver hypnozoites, tafenoquine was preferred but unavailable, so the patient completed a 14-day course of primaquine. He had no evidence of recurrence at 1- and 3-month follow-up.

Overall, the report emphasizes that clinicians should consider relapsed malaria in patients with a prior <em>P. vivax</em>/<em>P. ovale</em> history and should choose therapy based on resistance patterns, drug interactions, and medication access.

Asset Subtitle

Basil McIntosh

Meta Tag

Author List Basil McIntosh, Eli Wilber

Category Clinical Vignettes

Concept Relapsed Malaria

Concept Acute Antimalarial Therapy

Concept Hypnozoite

Concept Plasmodium vivax

Concept Plasmodium ovale

Distinguished Non-Finalist

Presenter Organization Emory School of Medicine

Presenting Author Basil McIntosh

Track Adult

Keywords

Plasmodium vivax

relapsed malaria

hypnozoites

primaquine

atovaquone-proguanil

rifampin interaction

chloroquine resistance

non-falciparum malaria

febrile illness

parasitemia

Relapsed Malaria

Acute Antimalarial Therapy

Hypnozoite

Plasmodium vivax

Plasmodium ovale