The

n e w e ng l a n d j o u r na l

of

m e dic i n e

TEACHING points

MANIFESTATIONS, DIAGNOSIS, AND TREATMENT OF PARASITIC INFECTIONS

Recent and remote travel history is an important part of the evaluation of a patient
who presents with an acute febrile illness.
In appropriate clinical circumstances, a peripheral-blood smear can be used to
diagnose parasitic infection.
Malaria is a protozoan infection endemic in tropical and subtropical regions of the
world and is responsible for hundreds of thousands of deaths each year. Although
infection with any plasmodium species will cause febrile illness, distinct differences
in the life cycles of certain species can result in relapse months or even years after
initial infection.
Many medications are available for the treatment of primary infection with malarial
parasites, but primaquine must be used in patients infected with Plasmodium vivax
and P. ovale in order to eliminate the disease reservoir in the liver. Travelers to
regions in which malaria is endemic must undergo malaria prophylaxis during their
travel and for a short period after leaving the region in order to prevent
infection.

These teaching points are drawn from the Interactive Medical Case. For more complete information,
see Redig AJ, Vaidya A, Price C, Katz JT, Maguire JH. A chilly fever. N Engl J Med 2014;371:e24.