Assignment task: A 40-year-old man, a resident of the United States, presents to an emergency room with a 5-day history of fever, chills, nausea, vomiting, and myalgias. He returned 2 weeks ago from a 16-day visit to Zambia.
Question 1: What chemoprophylaxis regimen (if any) should be recommended for travel to Zambia? (more than one might apply)
Question 2: Based on the observed time intervals, could the symptoms experienced by the patient be due to malaria?
Some days later, the patient was seen at another clinic, where on a routine CBC malaria parasites were seen. He was then referred to a hospital, where he presented to the emergency room, at 4 am, with continuing fever, nausea, vomiting, and myalgias. On physical examination, the patient is febrile (102°F), and tachycardic. he was jaundiced and pale. He is well-oriented but slow in answering questions. A thin blood smear obtained in the emergency room is read as Plasmodium, species not determined. Other laboratory findings include hematocrit 33% , creatinine 3.6 mg/dL, and total bilirubin 11.0 mg/dL. The urine is dark, with a measured output of 40 mL/6 hours.