Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • fever or hx of fever

Other diagnostic factors

  • headache
  • weakness
  • myalgia
  • arthralgia
  • anorexia
  • diarrhea
  • seizures
  • nausea and vomiting
  • abdominal pain
  • pallor
  • hepatosplenomegaly
  • jaundice
  • altered level of consciousness
  • hypotension
  • anuria/oliguria
  • influenza-like respiratory symptoms

Risk factors

  • travel to endemic area
  • inadequate or absent chemoprophylaxis
  • insecticide-treated bed net not used in endemic area
  • settled migrants returning from travel to endemic area of origin
  • low host immunity (for severe disease)
  • pregnancy (for severe disease)
  • age <5 years (for severe disease)
  • immunocompromise (for severe disease)
  • older age (for severe disease)
  • iron administration (children)

Diagnostic investigations

1st investigations to order

  • Giemsa-stained thick and thin blood smears
  • rapid diagnostic tests (RDTs)
  • CBC
  • clotting profile
  • serum electrolytes, BUN and creatinine
  • serum LFTs
  • serum blood glucose
  • urinalysis
  • arterial blood gas
Full details

Investigations to consider

  • PCR blood for malaria
  • chest x-ray
  • blood culture
  • urine culture
  • sputum culture
  • lumbar puncture
  • HIV test
  • PCR nasopharyngeal swabs for influenza
  • CT head
Full details

Emerging tests

  • loop-mediated isothermal amplification
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant in Tropical and Travel Medicine

Hospitals for Tropical Diseases

Senior Lecturer

London School of Hygiene and Tropical Medicine

London

UK

Disclosures

RB is on the advisory board of Sigma Tau and on the Public Health England advisory committee for malaria prevention. His employer has received research payments from Sigma Tau. RB is an author of a number of references cited in this monograph.

Specialty Registrar in Infectious Diseases and Medical Microbiology

Hospital for Tropical Diseases

University College London Hospitals NHS Foundation Trust

London

UK

Disclosures

MM declares that she has no competing interests.

Dr Ron Behrens and Mariyam Mirfenderesky would like to gratefully acknowledge Dr Signe Maj Sorensen, Dr Joanna Allen, Dr Simon Warren, and Dr Behzad Nadjm, previous contributors to this monograph. SMS, JA, and SW declare that they have no competing interests. BN is an author of a reference cited in this monograph.

Peer reviewers VIEW ALL

Professor

Head of the Travel Clinic

Consultant of Tropical and Travel Medicine

University Hospital

Project leader

Swiss Tropical and Public Health Institute

Basel

Switzerland

Disclosures

BG has received a research grant from Novartis Pharma to assess the impact of the introduction of artemether-lumefantrine (Novartis) as first-line treatment for uncomplicated malaria on mortality of children under 5 years old in 2 districts in Tanzania and travel grants from Novartis Pharma to present the results of the study above. BG is an author of a reference cited in this monograph.

Associate Professor

Malaria Research Institute and Department of Molecular Microbiology and Immunology

Johns Hopkins Bloomberg School of Public Health

Baltimore

MD

Disclosures

DS has received royalties from antigen provision for a diagnostic test to Inverness. DS with Johns Hopkins University has patents on diagnostic tests that do not require blood.

Professor

Institute of Specific Prophylaxis and Tropical Medicine

Medical University of Vienna

Vienna

Austria

Disclosures

WHW declares that he has no competing interests.

Use of this content is subject to our disclaimer