Case 319 -- Two weeks in Africa

Contributed by Lirong Qu, MD, PhD and Lydia Contis, MD
Published on line in August 2002


The patient is a 16 year-old male who recently traveled to Sudan for two weeks. He took Lariam (Mefloquine) for malaria prophylaxis while he was in Africa and for the first three weeks he was back in the US. He forgot the fourth dose that he was scheduled to take. Two weeks later, he began to experience fatigue, diarrhea, nausea and vomiting. These symptoms came and went without any specific patterns. Hematologic analysis did not reveal any hematologic abnormalities at that time. Two weeks later his symptoms worsened. He developed fever, orthostatic hypotension and a weight loss of 15 pounds. He was admitted to the hospital for treatment.


Laboratory findings at admission revealed a normochromic normocytic anemia, neutropenia and thrombocytopenia (Table 1) with an elevated RDW. The blood smear showed polychromasia and schistocytes (Figure 1, Figure 2), ring form organisms within red blood cells (Figure 3, figure 4) and a banana shaped organism (Figure 5, Figure 6). The parasite load was estimated to be 0.5%. His treatment regimen involved re-hydration, Tetracycline and Quinin. He responded well to the therapy and on hospital day 3, his blood smear was negative for the presence of any organisms. He was discharged from the hospital with continuing therapy for one week.


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