# Falciparum Malaria in Japan: Diagnostic Difficulty in Non-endemic Areas and the Importance of Immediate Referral

## TL;DR

A case of falciparum malaria in Japan is described, emphasizing the need for prompt referral to specialized institutions for accurate diagnosis and treatment.

## Contribution

The paper highlights the critical role of immediate referral in diagnosing and managing falciparum malaria in non-endemic areas.

## Key findings

- A patient with falciparum malaria was successfully treated after being referred to a specialized hospital.
- Non-specific symptoms and lack of diagnostic resources in initial institutions can delay diagnosis.
- Prompt referral is essential for managing malaria in non-endemic regions.

## Abstract

In Japan, malaria is rare, and only a few institutions have the diagnostic capabilities to treat it. In falciparum malaria, the symptoms and signs of the disease are non-specific, and diagnostic delay in symptomatic patients can be fatal. Herein, we describe a case of falciparum malaria that achieved good outcomes in a patient who initially visited an institution in Japan that lacked malaria diagnostic resources. A female patient in her twenties was admitted to the emergency department with a high fever. She developed a fever three days after returning to Japan from Guinea, a malaria-endemic region. Additionally, she exhibited impaired consciousness, tachycardia, and tachypnea. Her laboratory results indicated an increased inflammatory response, thrombocytopenia, hyperbilirubinemia, and coagulopathy. Computed tomography revealed hepatic enlargement and splenomegaly. Based on these findings, malaria was suspected, and the patient was immediately referred to an infection-specialized hospital. There, the patient was diagnosed with falciparum malaria and was treated and discharged without increased severity. This case highlights the importance of promptly referring patients suspected of malaria who are returning from endemic areas to institutions with relevant diagnostic resources if required resources are unavailable.