# Challenges of diagnosing severe malaria with complications in adult patients: a case report

## TL;DR

A 46-year-old man in Jakarta was diagnosed with severe falciparum malaria after initial negative tests, highlighting the importance of timely and accurate diagnosis.

## Contribution

This case report highlights the diagnostic challenges of severe malaria in non-endemic areas with no travel history.

## Key findings

- Initial diagnostic tests for malaria were negative, leading to delayed treatment.
- The patient's condition improved after a positive malaria test and administration of artesunate.
- The case was classified as introduced malaria due to Jakarta's non-endemic status.

## Abstract

Malaria is known to be the main cause of death in malaria-endemic areas. The authors report a case of severe malaria in an adult with no history of travel from an endemic area with good outcomes after hospitalization.

A 46-year-old man was brought to the Emergency Room (ER) because of fever and chills for 6 days. Complaints were accompanied by nausea and vomiting three times a day. The patient also experienced headaches, weakness, coughing, and a runny nose after two days of admission. The patient had no history of traveling from a malaria-endemic area. The patient was transferred from the Emergency Department (ED) to the High Care Unit (HCU), and during 1 day of intensive care at the HCU, there was a clinical deterioration characterized by dyspnea, icteric sclerae, acral edema, tenderness in both calves, and rash in the abdominal area. Due to worsening respiratory function, the patient was placed on a ventilator. During intensive treatment, the patient continued to show deterioration. The clinical findings suggested a possible feature of Weil’s disease or fulminant hepatitis, and although the patient was in intensive care, there was no clinically significant improvement. Furthermore, microscopic blood smear examination and rapid diagnostic tests (RDTs) for malaria were carried out on the 4th day of treatment with negative results. As there was no clinically significant improvement, it was decided to take a blood smear and repeat RDT on the twelfth day, which showed a positive result for falciparum malaria. Subsequently, artesunate was administered intravenously, and the patient’s condition began to improve with a negative parasite count the following day. The patient was discharged in good clinical condition on day 25 of treatment.

Good quality malaria diagnostic techniques are essential to diagnose malaria. A timely diagnosis of malaria has the potential to save the patient. Because Jakarta is not a malaria endemic area, it was concluded that this case was an introduced malaria case.