SHM Converge Scientific Abstract ePoster Gallery-Malaria Without Recent Travel

Pdf Summary

This case describes a previously healthy 23-year-old man who presented with three nocturnal fevers over one week and no other symptoms. He had emigrated from the Democratic Republic of Congo in 2020 and had no international travel since then. He also reported a prior malaria infection at age 19, during which he experienced severe fatigue.<br /><br />On evaluation in the ED, he was febrile and tachycardic. Initial labs showed lymphopenia, thrombocytopenia, and elevated bilirubin. An extensive infectious workup was negative, and CT imaging did not reveal lymphadenopathy. A blood smear demonstrated trophozoites within red blood cells with 1% parasitemia, most consistent with Plasmodium vivax. Testing also showed absent G6PD enzyme activity.<br /><br />The case highlights malaria relapse from dormant liver-stage hypnozoites, which can remain inactive for years before causing recurrent infection. P. vivax and P. ovale are particularly known for this pattern. Malaria treatment is stage-specific: blood-stage infection can be treated with agents such as artemether-lumefantrine or chloroquine, while eradication of dormant liver forms requires primaquine or tafenoquine. However, these drugs can cause severe hemolysis in patients with G6PD deficiency.<br /><br />He was treated acutely with artemether-lumefantrine, then discharged on weekly chloroquine for one year to reduce relapse risk. Definitive cure was not possible because of his G6PD deficiency, which made primaquine and tafenoquine unsafe. The prior fatigue during his earlier malaria treatment may have represented hemolysis from unrecognized G6PD deficiency.<br /><br />This case emphasizes that malaria relapse should be considered even without recent travel, especially in immigrants from endemic regions, and that G6PD deficiency significantly limits curative treatment options.

Asset Subtitle

Jaimie Patel

Meta Tag

Author List Jaimie Patel, Jordan Hill, Olivia Nester

Category Clinical Vignettes

Concept Malaria

Concept Hypnozoite

Concept Glucose-6-Phosphate Dehydrogenase Deficiency

Concept Plasmodium vivax

Concept Plasmodium ovale

Distinguished Non-Finalist

Presenter Organization Ohio State University Division of Hospital Medicine

Presenting Author Jaimie Patel

Track Adult

Keywords

malaria relapse

Plasmodium vivax

G6PD deficiency

hypnozoites

blood smear

thrombocytopenia

immigrant from Congo

artemether-lumefantrine

primaquine

tafenoquine

Malaria

Hypnozoite

Glucose-6-Phosphate Dehydrogenase Deficiency

Plasmodium vivax

Plasmodium ovale