Synopsis
Prevent malaria in travellers, recognise infection immediately after endemic exposure, obtain definitive parasite testing without delay, and deliver species- and severity-appropriate treatment safely.
- Malaria is transmitted by female Anopheles mosquitoes; P. falciparum causes most fatal imported disease, while P. vivax and P. ovale can relapse from dormant liver hypnozoites.
- Fever after malaria-risk travel, often with headache, myalgia, rigors or gastrointestinal symptoms, is the key trigger; a regular cycle is not required.
- First-line diagnosis is urgent expert thick and thin blood-film microscopy with parasite density; add a rapid diagnostic test, but never use it as the sole rule-out test.
Key red flags
Any fever or systemic illness after travel to a malaria-risk area requires same-day malaria testing, even when prophylaxis was taken or another diagnosis appears plausible.
Fever, sweats or rigors after time in a malaria-risk area is the cardinal trigger for urgent testing, regardless of prophylaxis use or elapsed months.
Investigation priorities
Detect parasites, identify species, quantify parasitaemia and provide a baseline for response.
Management branches
A patient is febrile or reports recent fever after travel to any malaria-risk area.
- Record precise countries, regions and dates, then send urgent thick and thin films plus a rapid diagnostic test through a laboratory able to report immediately.
- Perform ABCDE and check bedside glucose while obtaining FBC, renal and liver profiles, coagulation, gas and lactate; assess pregnancy and oral absorption.
Key medicines
Intravenous artesunateGive 2.4 mg/kg intravenously at 0, 12 and 24 hours, then 2.4 mg/kg every 24 hours until reliable oral treatment is possible, followed by a complete effective oral course.
Artemether-lumefantrineFor an adult weighing at least 35 kg, give four tablets containing 20 mg/120 mg each at 0, 8, 24, 36, 48 and 60 hours with food containing fat.