November 27, 2019
There are annually around 1,700 cases of malaria diagnosed in the United States. University of Alabama Family Medicine residents encountered one of these cases in Tuscaloosa, Alabama.
Three residents and a third-year medical student presented their experience treating a severe case of malaria during the College of Community Health Sciences Grand Rounds lecture November 19.
Drs. Stephanie Kinsley, Ellen Cleland and Tony Johnson, and medical student Cole Marshall, shared the initial visit, worsening symptoms, diagnosis and process of keeping the U.S. Centers for Disease Control and Prevention informed of the infectious disease case.
The patient initially visited an urgent care center. Influenza was suspected, but the test came back negative, said Kinsley. The patient did not respond to a steroid injection administered by the urgent care facility after one week and was admitted to the DCH Regional Medical Center emergency department with worsening symptoms.
A health history showed that the patient had immigrated from Africa 11 years ago. The patient took annual trips to Nigeria and had a mild case of malaria after a recent trip. The patient had not received the recommended vaccine before leaving the U.S. Lab results showed a red blood count consistent with malaria, said Johnson. The patient was admitted to DCH Family Medicine service.
There are five mutations of malaria that can be transferred to humans by the Anopheles mosquito. Of the five, plasmodium falciparum is the most likely to result in a severe, fatal infection. The patient’s initial peripheral smears identified plasmodium falciparum, said Marshall.
With the more serious cases of malaria, there is a risk of severe anemia, hemoglobinuria due to hemolysis, hypoglycemia, as well as other symptoms largely revolving around the loss of healthy red blood cells, according to the lecture presenters.
The CCHS Grand Rounds series, which provides Continuing Medical Education for physicians and other health professionals, is designed to help medical professionals and learners look at past cases and learn from the investigative process. In this case, the speakers educated the audience about the four main factors to guide treatment: identifying the plasmodium species, clinical status, expected drug susceptibility and previous use of antimalarials, including chemoprophylaxis.
They also highlighted the interprofessional collaboration in treating a rare and potentially fatal disease. The CDC, nursing staff, pathology, laboratory, pharmacy and on call clinicians were integral to the success of treating the patient effectively and according to procedure.
Using the recommended medication, artesunate, the patient survived the initial treatment for malaria. The patient was readmitted with anemia one week later and given transfusions. The patient was discharged after an additional three days in the hospital. Artesunate is not FDA approved and is only available in Investigational New Drug protocol from the CDC for extenuating circumstances, such as in this patient’s case.