JAMA Clinical Challenge: Fever in a Traveler Returning From Africa

I enjoyed the recent JAMA Clinical Challenge case.

A 35-year-old man presented to the emergency department with 4 days of fever, extreme weakness, fatigue, and confusion. He was born in the United States but had traveled to Sierra Leone for a period of 3 weeks and had returned 1 week prior to presentation. He was diagnosed with P. Falciparum malaria based on smear, treated, and recovered.

The main issue I was thinking about was why he did not take any form of malaria prophylaxis, nor did he use insect repellent, mosquito netting, etc, while traveling. These precautions take effort but are essential. He is lucky to have survived.

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