A 22-year-old woman returns from a holiday on the Kenyan coast

A 22-year-old woman returns from a holiday on the Kenyan coast. She develops a fever,
deteriorates over the next 48 h and becomes unconscious and unrousable. She has acute
renal failure. Which one of the following options is the most appropriate investigation?

  • A Computed tomography (CT) scan, head
  • B Electroencephalograph (EEG)
  • C Erythrocyte sedimentation rate (ESR)
  • D Repeated thick and thin blood smear
  • E C-reactive protein (CRP)

0 voters

Complications in malaria treatment
The patient in the present case has extremely severe falciparum malaria, with cerebral
malaria (coma) and renal failure (usually pre-renal) needing renal replacement therapy
Patients with full-blown cerebral malaria are at an increased risk of fitting, which may
be treated with diazepam
Administration of prophylactic anticonvulsants may be associated with an increased
Exchange transfusion is recommended for a parasitaemia > 10% with complications (or

30% if no other complications)
Treatment of the malaria is with IV quinine, which increases insulin secretion and the
sensitivity of cells to insulin and can cause hypoglycaemia
Malaria itself can cause hypoglycaemia too, so blood glucose should be monitored
every 2 h