A traveller returning from sub-Saharan Africa presents with high-grade fever, chills, headache, and splenomegaly. Blood smear shows 'banana-shaped' gametocytes. Which complication is this patient most at risk of, and what urgent investigation should be prioritized?

• A Rupture of spleen; urgent surgical review
• B Quartan malarial nephropathy; urine microscopy
• C Cerebral malaria; thick and thin blood smear with parasite count and organ function tests ✓
• D Splenic sequestration syndrome; bone marrow biopsy

Explanation

Banana-shaped (crescent-shaped) gametocytes are pathognomonic of Plasmodium falciparum, the species responsible for malignant tertian malaria and its life-threatening complications including cerebral malaria, severe anaemia, acute kidney injury, pulmonary oedema, and hypoglycaemia. Urgent investigations include parasite count on thick/thin smear, RFT, LFT, blood glucose, and haematocrit. Quartan malarial nephropathy is caused by P. malariae (which shows band-form trophozoites). Splenic sequestration with crisis is seen in sickle-cell disease with P. falciparum.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.