Synopsis
Assess fever after international travel by stabilising first, excluding malaria immediately, reconstructing exposure and incubation, applying isolation early and selecting targeted microbiology before empirical treatment.
- Ask exactly where and when the patient travelled, including stopovers, urban versus rural setting, dates, season and illness onset; incubation time removes many impossible diagnoses.
- Malaria is the first exclusion after travel to a risk area because falciparum disease can deteriorate rapidly and prophylaxis does not provide complete protection.
- Take a precise exposure history: mosquitoes and ticks, fresh water, animals, food and water, sexual contact, healthcare, caves, funerals, mass gatherings and sick contacts.
Key red flags
Fever with rigors, headache, cytopenia, jaundice, confusion, acidosis or renal injury after malaria-area travel is an emergency even without a regular fever pattern.
Investigation priorities
Detect malaria species, parasitaemia and features requiring severe-disease management.
Management branches
Any current or recent fever follows travel to an area with malaria transmission.
- Perform ABCDE, check glucose and travel dates, take urgent malaria films and rapid testing and request infection or tropical-medicine advice.
- Assess severity including consciousness, lactate or acidosis, renal function, jaundice, anaemia, respiratory compromise and parasitaemia; admit and treat promptly when severe or falciparum malaria is possible.
The traveller is physiologically stable and immediate malaria and high-consequence pathways have been addressed.
Key medicines
Intravenous artesunateGive 2.4 mg/kg intravenously at 0, 12 and 24 hours, then every 24 hours until oral treatment is tolerated; after at least three doses, complete a full specialist-selected oral combination course.
Atovaquone with proguanilFor adults over 40 kg with selected uncomplicated falciparum malaria, give four 250/100 mg tablets orally once daily for three days with food.