How Not to Miss a Case of Malaria in Emergency Department in Malaria Non-Endemic Areas? Practical Approach & Experiences in Hong Kong

Abstract

Human malaria is a life-threatening mosquito-borne protozoan parasitic infection in human involving female anopheline mosquitoes as vector for transmission. It is caused by Plasmodium species, most commonly, P. vivax, P. ovale, P. malariae and P. falciparum, and rarely P. knowlesi. Malaria remains a significant global health issue and is a medical emergency. It is also an important cause of morbidity and mortality in endemic areas, particularly in at-risk groups. In Hong Kong, where malaria is non-endemic, more than 20 cases of malaria per year have been notified in recent years. We still have chances encountering patients with malaria presented to public or private emergency departments. High index of clinical suspicious is utmost important for not missing a case of malaria. A practical approach for prompt identification of patients with severe malaria is essential, followed by appropriate initiation of appropriate effective antimalarial treatment within 24 to 48 hours of symptoms onset after blood taken for thick and thin smears for diagnosis. Vigilance with increased awareness of not falling into common diagnostic traps has to be alerted. The risk of missing any case of malaria presenting to emergency department could be largely minimized.

The Phenomenon of the ‘Starry Sky’ on Blood: Lesson Learned From Severe Malaria Falciparum

“…Because Severe malaria requires rapid and prompt diagnosis and then followed by adequate anti-malarial treatment to avoid significant risk of further morbidity or mortality, we strongly recommend that a suspected case of severe malaria must always be treated as an emergency case [38,39]. Many cases of severe malaria, including our story of "Starry Sky", teach how time is the pivotal determinant of whether doctors can identify and clearly assess the magnitude of the problem at hand, determine the steps that need to be taken and implementing them as soon as possible while continuing to evaluate the patient's progress [39,40].…”