Eve B. Hoover is completing a postgraduate academic fellowship at Midwestern University at Glendale, Arizona, and practices at Logistics Health, Inc, in Phoenix. The author has no significant financial relationships to disclose.
PATIENT PRESENTATION A 19-year-old previously healthy male student presented to the university health clinic for evaluation. During the exam, he lay on the examination table, covered with a blanket and shaking uncontrollably with intense rigors. Although he was hesitant to answer questions due to feeling so ill, he reported that he had returned from India two weeks prior and his symptoms—fever, rigors, ache, fatigue, headache, and nausea—began abruptly, hours before his arrival at the clinic.
The patient was diaphoretic and taking rapid, shallow inspirations. Assessment of vital signs revealed a blood pressure of 148/86 mm Hg; respiratory rate, 24 breaths/min; temperature, 103°F; and heart rate, 112 beats/min.
HEENT evaluation showed dry mucous membranes but no other abnormality. Neck was supple with no lymphadenopathy or nuchal rigidity. On cardiac exam, there were no murmurs or rubs. Lungs were clear to auscultation. Abdomen was soft and nontender, and bowel sounds were present in all four quadrants. There was no costovertebral angle tenderness. Skin was warm, clammy, and without rash. There were no focal neurologic deficits.
Complete blood count, comprehensive metabolic panel, and urinalysis were without abnormality. Examination of thick and thin blood smears revealed multiple red blood cells (RBCs) infected with malaria parasites and the appearance of the classic “headphone” form within the cells. Based on the in-office laboratory results of the blood smear, the patient was diagnosed with malaria.
The patient was not surprised by the diagnosis, as he had experienced these same symptoms with previous bouts of malaria. He and his family were from India, and the patient was an international college student. He had not taken malaria chemoprophylaxis prior to his most recent trip. After a short hospital admission for hydration, observation, treatment, and consultation by an infectious disease specialist, the patient was released back to the demands of college life.
