Travellers
Diagnosing malaria in travellers
The majority of medical professionals in non-endemic countries are inexperienced in malaria diagnosis and treatment because they rarely encounter the disease. Diagnosis of malaria in patients from non-endemic countries must not rely on the clinical presentation alone; it should start with a travel history, and care should be taken to rule out influenza, the most common misdiagnosis. The same applies to other disorders suggested by symptoms commonly associated with malaria fever, such as diarrhoea, vomiting, anorexia, cough, and abdominal pain. See Making sense of the febrile traveller: a differential diagnosis guide. Also, malaria may not be considered because it shares signs and symptoms with other tropical illnesses (including typhoid fever), rheumatic fever, and bacterial meningitis.
It is therefore important to suspect malaria and seek a laboratory diagnosis in all febrile patients who have left a malarious area within 3 months (or even up to a year). This includes travellers who took malaria chemoprophylaxis medication while visiting endemic areas, or air crew or travellers briefly exposed at airports in malaria endemic zones.
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Early diagnosis and treatment is lifesaving; falciparum malaria can kill if treatment is not started early in the infection especially in vulnerable children and pregnant women. If the diagnosis of malaria is suspected, treat first, then arrange for definitive diagnosis. |
