A 22 year old man presents with fever for 10 days, in association with chills and sweating. One month ago, he returned from a trip to Ecuador, where he consumed the local food and water, traveled in the jungle, swam in a local lake, and received many insect bites. He had been vaccinated against hepatitis B and yellow fever before the trip. His medical history is unremarkable. He has a single stable sexual partner and denies using recreational drugs.
Hb: 11.9 g/dL (12-18.5) Hct: 43.2 WBC: 5,000/mm3 (5,000-10,500) N: 84%, L: 10% Platelets 92,000/mm3 (150,000-500,000)
A lumbar puncture will be arranged tomorrow.
Bilirubin 1.3 mg/dL (0.1-1.0) Albumin 4.4 g/dL (3.5-5.0) Total Protein 6.8 g/dL AST 82 U/L (8-48) ALT 97 U/L (7-55) GGT 52 U/L (9-48)
Both thin and thick smears of peripheral blood show malarial parasites with a red nucleus and blue cytoplasm, within enlarged red cells.