A 28-year-old male was brought into the emergency room with significant complaints of fatigue, chills, fever, and lack of appetite. The patient was hospitalized after experiencing joint discomfort, a dry cough, and epigastric burning for three days prior to admission. The patient complained of deteriorating symptoms, such as fatigue and an epigastric burning sensation, on the day of admission. He had some sense of direction, was awake, and could speak well. One year ago, the patient visited malarious area for business. There was no prior history of malaria in the patient. He was not given any anti-malarial medication while traveling to his workplace. His vital signs revealed a 38.1 oC body temperature, a blood pressure of 121/77 mm Hg, and a heart rate of 101 beats per minute.While inhaling room air, the patient's oxygen saturation was 96%.
His laboratory investigations revealed a hemoglobin level of 13.7 g/dL, a hematocrit of 38.4%, blood urea nitrogen of 43 mg/dL, fasting blood glucose of 117 mg/dL, an aspartate aminotransferase level of 47 units/L, an alanine aminotransferase level of 40 units/L, an erythrocyte sedimentation rate of 13 mm/hour, a white blood cell count of 4,850/mL, a platelet count of 61,400/mm3, a serum creatinine level of 2.7 mg/dL, neutrophils of 87%, lymphocytes of 7%, and monocytes of 1%. Other serum electrolytes, including serum liver enzymes, except serum potassium and sodium levels, were found to be within the normal range. As a result of laboratory investigations to identify malarial parasites in peripheral blood using thin and thick smears, malaria parasites were found in the patient. He was sent to an urgent care facility after being diagnosed with severe malaria after peripheral thin blood film discovered P. falciparum trophozoites.
Cardiac and pulmonary sounds were normal. Examination of the head, eyes, ears, nose, and throat revealed a swollen face with pink conjunctiva. Cardiovascular testing confirmed that S1 and S2 were audible. At the border of the costa, the liver was palpable. Both the chest X-ray and abdominal ultrasonography were clear. His level of consciousness assessment indicated a Glasgow coma scale reading of 10 out of 15. His electrocardiogram revealed sinus tachycardia with an ST-segment of 0.07 seconds and a heart rate of 114 beats per minute. He had a big, round, non-tender belly that was dull but not organomegalic.
He received 1000 ml of normal saline solution with 40% glucose solution as supportive care for her condition. When he was admitted to the critical care unit and at intervals of twelve and twenty-four hours for the next three days, he received intravenous artesunate 60 mg (2.4 mg/kg). The patient was shifted to oral dosages of 20 mg artemether and 120 mg lumefantrine, four tablets twice a day for three days following the final dose of artesunate (a total of three doses, 540 mg).
Patient perspective
After four days in the hospital, he made a partial recovery and was eventually released after clinical and laboratory tests revealed a noticeable improvement. He gave advice as he would visit a nearby clinic in a month.