Malaria

A 5-year-old boy presented with a history of high-grade fever with chills and rigors and headache for 6 days and with vomiting and mild cough for 2 days. The temperature was documented to be more than 40 °C at home. He was voiding urine well and was active in between febrile episodes. Physical examination revealed a temperature of 39.5 °C and normal vital signs. He had mild, nontender hepatomegaly and splenomegaly. There was no significant pallor or lymphadenopathy. He had visited his relatives in Odisha 3 weeks ago. A provisional diagnosis of enteric fever was made. The possibility of malaria was also considered in view of his recent visit to an endemic area. He was hospitalized and was started on IV ceftriaxone after sending blood for routine investigations and culture. His hemoglobin level was slightly low, and liver enzymes showed a mild increase. Other lab tests were normal. His peripheral blood film was positive for the ring forms of Plasmodium falciparum. He was able to take oral feeds, and the blood sugar was normal. Serum electrolytes and renal function tests were normal. He was diagnosed with uncomplicated falciparum malaria, and artemisinin-based combination therapy was started. The child responded very well with fever defervescence in a day. A single dose of primaquine also was given to prevent malarial transmission. Blood culture was sterile and the antibiotic was stopped. He was discharged and he continued to be in good health on review after 1 week.