Only 10 patients (20%) had taken any prophylaxis to prevent malaria. Five of these took a drug that was inappropriate for the country to which they traveled. P. falciparum was most common (74%). P. vivax, P. ovale, and P. malariae were present in five, three, and one case, respectively.

In four cases, definitive species identification was not possible due to the low percent parasitemia, with just a few ring forms present. No coinfections were seen. The majority of patients (52%) had parasitemia <1%; only seven patients had hyperparasitemia (>5%). The maximum parasitemia was 28.6%. All cases with >5% parasitemia were P. falciparum. Nonfalciparum forms made up 42% of patients with ≤1% parasitemia selleck kinase inhibitor and 12% of those with 1% to 5% parasitemia. Gametocytes were rarely identified. Laboratory results are presented in Table 2. Thrombocytopenia and anemia were the most commonly observed laboratory abnormalities. Mild hyponatremia was also relatively common (36% had sodium ≤135 mEq/L and 12% had sodium ≤130 mEq/L). G6PD levels were measured in 10 children; only one was G6PD deficient. Six patients were tested for sickle cell disease; all were negative. Two patients had known sickle trait. Thirty-four children (68%) were hospitalized for treatment of malaria, with a maximum stay of 9 days. Among those with P. falciparum malaria, 75% were hospitalized;

17% stayed for only 1 day. Documentation of treatment available in 41 children: 18 patients (44%) received quinine and doxycycline, eight (19%)

quinine/quinidine and clindamycin, four (9.7%) received atovaquone–proguanil, six (15%) received only one drug (quinine, choloroquine, DOCK10 or primaquine), and the rest received other selleck products combinations. Several children received antibiotic therapy due to concern for additional diagnoses. Sixteen patients had received antimalarial therapy previously, although in some cases this was several months prior. One patient received a blood transfusion for anemia (hemoglobin 5.4 mg/dL). No exchange transfusions were performed. One patient received platelet transfusion for a platelet count of 32,000/ul. All of the patients recovered without serious complications. This case series demonstrates the wide spectrum of possible clinical presentations which may be seen with malaria including vomiting, diarrhea, headache, abdominal pain, etc. Gastrointestinal symptoms can be so severe that an intestinal infection may be suspected. Hepatosplenomegaly may be seen; this was less common in our series than in other reports.14,15 In contrast to the report by Viani and Bromberg,14 hyponatremia was not a common finding. One almost universal symptom is fever, either by history or at presentation. Because malaria may present with a wide variety of clinical symptoms, a high index of suspicion is required to ensure prompt diagnosis. Primary care providers seeing patients with a history of fever should always ask about a history of travel and request the appropriate diagnostic tests.