Malaria in children: Case

This child has imported Plasmodium vivax malaria, the classic relapsing species seen in children returning from Papua New Guinea and South Asia. Her fever, pallor, and splenomegale, alongside a low parasitaemia and an alert conscious level with no severity features, place her in the uncomplicated category, which means oral therapy rather than intravenous artesunate. The distinctive issue with vivax is the dormant liver hypnozoite, which causes relapse unless a radical cure is given. ^[1]

Clinical findings

The key findings are the travel history to Papua New Guinea six weeks earlier, the splenomegaly that points to a parasitic process, and the low parasitaemia without severity features. She is alert and haemodynamically stable, has no respiratory distress, and her blood film shows vivax rather than falciparum. The differential includes the other travel-related fevers, but the blood film is definitive and the species identification changes both the acute treatment and the need for radical cure. ^[1]

Because she has no World Health Organization severity features, she does not need intravenous artesunate or intensive care, but she does need a full blood count to define her anaemia and a glucose-6-phosphate dehydrogenase assay before any primaquine is given. A child returning from Southeast Asia with a film that looks like malariae but with a higher density should instead raise the question of knowlesi, which is managed as falciparum with an artemisinin-combination therapy. ^[3]