A 41 y.o. male presents with fatigue, fever , body aches and jaundice
What are the important parts of the history?
bilateral patchy infiltrates are seen in the lower lobes.
Our patient had falciparum malaria. The key questions to ask would have been travel since the patient just returned from Uganda. He could not obtain clean drinking water so for several days he did not take his malaria prophylaxis. He was found to have a plasmodium falciparum antigen at a primary care visit and was referred here for treatment with IV artesunate. His stool was also positive for campylobacter
The asexual stage is most relevant for human disease: beginning in the liver and then infecting RBCs
Artesunate was approved in 2020 and is the first-line drug for treatment of severe malaria in the United States. The criteria for severe malaria include at least one of the following : parasite density >5%, seizures, shock, pulmonary edema, acidosis, AKI, DIC, jaundice or Hgb <7.
It is a semisynthetic derivative of artemisinin; a product of the Chinese herb Artemisia annua. There are 300 cases per year in the US requiring treatment. However, malaria used to be very common in the US.
Quinine tonic was manufactured in St. Louis
While malaria is thought of as a parasite in the developing world affecting 40% of the world’s population it was once endemic in the US. In 1911 Charles Bass cultivated the plasmodia in vitro using human blood and research on quinine accelerated . Malaria tonic was manufactured in St. Louis
In 1947 the malaria eradication program began in the United States. The disease was eradicted by 1951 With the application of insecticides and eliminating standing water .
After hospitalization, the pt received IV artesunate because of vomiting. His developed leukopenia, hemolysis and thrombocytopenia to 25,000 and creatinine increased to 2.77. Bilirubin peaked at 5.5
http://resource.nlm.nih.gov/101453070
Bass, C. A new conception of immunity: its application to the cultivation of protozoa and bacteria from the blood and to therapeutic measures. Journal of the Amerian Medical Association 57, no 19(1911):1534-35.
Su X, Miller L. The discovery of artemisinin and Nobel Prize in Physiology or Medicine. Sci China Life Sci. 2015 Nov;58(11):1175-79.
Tilley L, Dixon M, Kirk K. The plasmodium falciparum-infected red blood cell. Int J Biochem Cell Biol. 2011 Jun;43(6):839-42. Doi: 10.1016/j.biocel.2011.03.012.