IPLab:Lab 11:Malaria

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Clinical Summary

This 46-year-old forestry consultant presented with a seven-day history of mild abdominal cramping, diarrhea, mild myalgias, gradually worsening headache, and subjective fever. The patient had recently returned from spending 5 months in the Thailand rainforests as a consultant to lumber companies. Stool cultures and repeated stool examinations for ova and parasites were negative. A presumptive diagnosis of viral gastroenteritis was made. Three days later the patient returned with a fever of 103° and bloody diarrhea. On examination the patient appeared acutely ill and had orthostatic hypotension. Exam was otherwise unremarkable. The patient was admitted and intravenous rehydration and broad-spectrum IV antibiotics were begun. Over the next eight hours the patient became progressively lethargic and finally became unresponsive to speech. His temperature rose to 106°. Careful examination of a peripheral blood smear revealed P. falciparum with a parasitemia of 5%. Intravenous antimalarial drugs were administered and over the next three days the patient's clinical condition gradually improved. Repeat peripheral smears at 3, 7, 14, and 28 days were negative for malaria.


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