Question 21.3

A 36-year-old patient who has returned from overseas, presents with fever, headache, nausea, general fatigue, and muscle ache. The blood film with Giemsa stain shows a parasitaemia level of 4%.

a)    List one other diagnostic test can be used to diagnosis malaria.    (10% marks)

b)    List the laboratory parameters which correlate with severity of illness.    (20% marks)

c)    List one specific treatment option.    (10% marks)

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College answer

Not available.


a)  One other diagnostic test could be any of the following:

  • Rapid diagnostic tests (RDTs), looking for
    • Parasite species-specific lactate dehydrogenase(pLDH)
    • Aldolase
    • Histidine-rich protein 2 (HRP2) - P.falciparum specific
  • Malaria PCR

b) Laboratory parameters that correlate with severity of malaria are:

  • Raise urea
  • Raised lactate
  • Acidosis
  • Liver failure (severe LFT derangement)
  • Anaemia
  • Evidence of DIC on coagulation studies
  • High parasite titer

c)   One specific treatment option could be:

  • Artesunate  + amodiaquine
  • Artesunate  + sulfadoxine–pyrimethamine
  • Artemether–lumefantrine
  • Dihydroartemisinin plus piperaquine
  • Artesunate plus doxycycline or clindamycin
  • Quinine plus doxycycline or clindamycin


Santos, Lurdes C., et al. "Severe imported malaria in an intensive care unit: a review of 59 cases." Malar J 11.1 (2012): 96.

World Health Organization. Guidelines for the treatment of malaria. World Health Organization, 2006.

We dont have a CDC here in Australia, and so I link to the CDC site for details about standardised diagnosis and treatment of malaria. This page has links to downloadable PDF documents with decisionmaking flowcharts et cetera. One particularly useful document is this set of Guidelines for Clinicians.

Trampuz, Andrej, et al. "Clinical review: Severe malaria." CRITICAL CARE-LONDON- 7.4 (2003): 315-323.

WHO. Guidelines for the treatment of malaria. 2nd ed. Geneva: WHO; 2010. Online.

Marks, M., et al. "Managing malaria in the intensive care unit." British journal of anaesthesia 113.6 (2014): 910-921.

Kwiatkowski, D., et al. "Anti-TNF therapy inhibits fever in cerebral malaria." QJM: An International Journal of Medicine 86.2 (1993): 91-98.

Varo, Rosauro, et al. "Adjunctive therapy for severe malaria: a review and critical appraisal." Malaria journal 17.1 (2018): 1-18.