A 32-year-old woman presents to the clinic with a three-day history of fever, headache, chills, and malaise. She also reports nausea and episodes of vomiting. She returned from a trip to sub-Saharan Africa five days ago, where she did not take malaria prophylaxis. Her travel included time spent in rural areas with significant mosquito exposure. Her past medical history is unremarkable, and she is not on any medications. She denies alcohol or tobacco use but mentions occasional recreational marijuana use. Her temperature is 102.2°F (39.0°C, blood pressure is 132/71 mm Hg, heart rate is 110 beats/min, and respirations are 18. On physical examination, she has scleral icterus and tachycardia. Laboratory results reveal anemia, thrombocytopenia, and elevated bilirubin. A peripheral blood smear shows ring forms within erythrocytes.
Which of the following is the most appropriate initial treatment?
The correct answer is:
A) Artemether-lumefantrine
Artemether-lumefantrine is the first-line treatment for uncomplicated malaria caused by Plasmodium falciparum in most endemic regions. This patient’s symptoms, history, and blood smear findings strongly suggest falciparum malaria.
Answer choice B: Doxycycline, is incorrect. Doxycycline is not a first-line agent for malaria treatment but can be used in combination with quinine in specific cases.
Answer choice C: Mefloquine, is incorrect. Mefloquine is primarily used for malaria prophylaxis, and its side effects make it less favorable for treatment.
Answer choice D: Primaquine, is incorrect. Primaquine is used for radical cure of P. vivax and P. ovale but is not useful for P. falciparum.
Answer choice E: Quinine and clindamycin, is incorrect. While quinine is used for severe malaria, artemisinin-based therapy is preferred for uncomplicated cases.
Key Learning Point
Artemisinin-based combination therapy is the preferred treatment for uncomplicated Plasmodium falciparum malaria regardless of chloroquine sensitivity.
