Associate Program Director Florida State University at Sarasota Memorial Hospital, United States
Introduction: Malaria is a potentially fatal disease that originates from the bite of a female Anopheles mosquito. (1) The three most common strains of Malaria occur through carriers infected with either p. falciparum, p. vivax, or p. ovale. The spread of malaria commonly follows a pattern of regional endemic spread. (2) Our case discusses the infection of an individual with no prior travel history or connection to a malarial endemic region.
Description: A 41-year-old male with no past medical history presents with nausea and vomiting for 10 days associated with 24-hour onset of severe abdominal pain and weakness. On examination, the patient was lethargic, tachycardic, hypotensive, and febrile. Further history gathered at the bedside revealed housing insecurity in a location with frequent insect stings and inadequate access to food and water intake. His physical exam was pertinent for diffuse pruritic eruptions and erythematous papules resembling insect bites. He was initiated on a sepsis protocol and his complete blood count was positive for intracellular parasites within the blood. A blood parasite screening test confirmed the presence of malaria using Giemsa and Wright staining. (3). The patient was initiated on artemether and lumefantrine (4). Despite fluid resuscitation, his blood pressure remained hypotensive requiring vasopressor support. His labs upon admission showed severe thrombocytopenia of 20, anemia with a hemoglobin of 11.6, acute renal injury with a creatinine of 2.27, a lactic acidosis of 5.7, and hypokalemia with a potassium level of 2.5. The patient required intensive monitoring with a 4-day intensive resuscitation of his septic shock. He also required aggressive correction of electrolyte derangements, monitoring of his platelet count, and extensive infectious disease evaluation. (5)
Discussion: Although malaria is predominately found in endemic regions or in individuals with a history of travel, it can also be seen in non-traveling individuals. It can present as a severe form of septic shock requiring extensive resuscitation and prompt anti-malarial treatment.
