Severe falciparum malaria

History and admission findings: A 57-year-old white man had been travelling in Kenya for vacation until 14 days before admission. Due to apprehension about side effects, the patient had refused any malaria prophylaxis. Ten da ys before admission he developed low grade temperatures and suffered from p ain in the limbs, from nausea and vomiting. A new episode of tachyarrhythmi a was diagnosed two days before admission and was treated by his general pr actitioner. Finally he was admitted to our hospital because of high tempera tures, chills and progressive clinical deterioration. Autopsy revealed prom inent congestion of liver, spleen and cerebral vessels as well as subdural and subarachnoidal hemorrhage. Investigations: In both thin and thick peripheral blood smears Plasmodium p arasites were demonstrated in approximately 30% of the eryhthrocytes and th e diagnosis of Plasmodium falciparum was immediately confirmed by an immuno logical test. Treatment and course: Due to the fulminant clinical and neurological deteri oration with progressive hypoxaemia, the patient required ventilator therap y already one hour after admission. Therapy with chinine and doxycycline wa s initiated and exchange transfusion was considered. However, due to hyperk alaemia and cardiac arrest, the patient died 4 hours after admission due to parasitic hemolysis. Conclusions: Severe Plasmodium falciparum infection in nonimmunized patient s is a medical emergency and requires immediate diagnosis and treatment. Ma laria should always be considered in the differential diagnosis in persons who have travelled to endemic areas and presenting not only with temperatur es, but also with non-specific clinical signs, like cardiac arrhythmias. Al though never entirely effective, chemoprophylaxis is highly recommended.