Tropical

A 22 year old man presents with fever for 10 days, in association with chills and sweating.

One month ago, he returned from a trip to Ecuador, where he consumed the local food and water, traveled in the jungle, swam in a local lake, and received many insect bites. He had been vaccinated against hepatitis B and yellow fever before the trip.

His medical history is unremarkable. He has a single stable sexual partner and denies using recreational drugs.

Select Relevant Investigations
Full Blood Count

Performed

Hb: 11.9 g/dL (12-18.5)
Hct: 43.2
WBC: 5,000/mm3 (5,000-10,500)
N: 84%, L: 10%
Platelets 92,000/mm3 (150,000-500,000)
Lumbar Puncture

Performed

A lumbar puncture will be arranged tomorrow.
Liver Profile

Performed

Bilirubin 1.3 mg/dL (0.1-1.0)
Albumin 4.4 g/dL (3.5-5.0)
Total Protein 6.8 g/dL
AST 82 U/L (8-48)
ALT 97 U/L (7-55)
GGT 52 U/L (9-48)
Blood for Malaria Parasites

Performed

Both thin and thick smears of peripheral blood show malarial parasites with a red nucleus and blue cytoplasm, within enlarged red cells.

Select Relevant Management
Screen Contacts
Chloroquine
Primaquine
Clindamycin