Snapshot A 36-year-old man presents to the clinic with a 2-week history of cyclic high-grade fevers, myalgia, chills, and night sweats. When asked about recent travel, he notes that he had been visiting his family in Ghana in the month prior to the onset of his symptoms. He is started on a treatment regimen of quinidine in combination with doxycycline. Introduction Pathogenesis transmission through bites of female Anopheles mosquitos Plasmodium life cycle involves 2 hosts: human and Anopheles mosquito human host login to view 14 more bullets Anopheles mosquito host login to view 4 more bullets 4 main species of Plasmodium cause malaria Plasmodium falciparum login to view 1 more bullet Plasmodium vivax login to view 1 more bullet Plasmodium ovale login to view 1 more bullet Plasmodium malariae login to view 1 more bullet Associated conditions occlusion of capillaries in the brain (cerebral malaria), kidneys, and lungs (Plasmodium falciparum) hemoglobinopathies (such as sickle cell disease) can be protective Epidemiology Geography endemic throughout most of the tropics disproportionately high burden of malaria in Sub-Saharan Africa Prevalence WHO estimated 216 million cases of malaria in 91 countries in 2016 Risk factors exposure to Anopheles mosquitos, particularly at dusk and dawn Presentation Symptoms fever, headache, anemia, splenomegaly Physical exam palpable spleen conjunctival pallor Studies Labs peripheral blood smear shows trophozoites and schizonts within erythrocytes trophozoite ring form within erythrocyte schizont containing merozoites red granules throughout erythrocyte cytoplasm seen with Plasmodium vivax and Plasmodium ovale Making the diagnosis most cases are clinically diagnosed Differential Babesiosis differentiating factor predominantly in northeastern United States Trypanosomiasis differentiating factors lymphadenopathy, somnolence, coma Borrelia recurrentis differentiating factor history of tick exposure Treatment Medical chloroquine used in areas with low drug resistance mefloquine used in areas with high rates of chloroquine resistance atovaquone/proguanil used in areas with high rates of chloroquine resistance primaquine used to kill latent hypnozoites in Plasmodium vivax and Plasmodium ovale infection intravenous quinidine or artesunate used in life-threatening situations Complications Cerebral malaria complication of Plasmodium falciparum infection parasitized erythrocytes occlude capillaries in the brain Renal failure complication of Plasmodium falciparum infection parasitized erythrocytes occlude capillaries in the kidney