She never developed hypoglycemia, blackwater fever or cerebral malaria. She completed a seven-day regimen of both quinine sulfate and tetracycline as an outpatient. Of interest, the patient did complain of ringing in her ears on therapeutic levels of quinine. Six months later she was seen in travel clinic for pretravel guidance, vaccinations and chemoprophylaxis before returning to West Africa for another visit with her relatives. A detailed history can narrow the differential for fever in a returning traveler.
Malaria is the most common cause of fever in a traveler returning from the tropics.
Plasmodium infections account for one-third of all acute febrile illnesses in returning travelers. Febrile travelers returning from areas endemic for malaria should be considered to have malaria until proven otherwise, since P. falciparum malaria can be rapidly fatal, but is curable with prompt, appropriate therapy. The diagnosis of malaria can be made by an untutored individual. The key to diagnosis lies in having a high index of suspicion for this disease. A thick smear in inexperienced hands may not add to diagnosis.