Management of severe Falciparum malaria on a mission: A case report

A sailor for forty-two years, in military service on the Italian aircraft carrier, while on a mission in sub-Saharan Africa, came to a physician due to fatigue with a fever, flu-like illness and headache for 6 days. The temperature was 38.8°C, BP 80/145 mmHg and RR 30/min. The oxygen saturation was 88%, while the patient was breathing room air. Laboratory findings showed that WBC count and platelet counts were greatly reduced. Blood smears were positive for Plasmodium falciparum malaria with more than 10 parasites per field. It began immediately antimalarial treatment. After 24 hours the patient showed a 50% reduction in parasitemia but continued to have tachypnoea, dyspnea and hypoxemia. A chest TC scan was then performed that revealed a right basal alveolar consolidation with bilateral pleural effusion. The patient was ultimately diagnosed with pneumonia and malaria (overlap syndrome). The patient began antibiotic and steroid therapy. After two days the fever was gone away and the clinical condition of the patient was greatly improved. The clinical overlap between pneumonia and malaria has important implications for case management strategies and their treatment should be integrated into community case management activities.