You are asked to review a 60-year-old Greek man with known glucose-6-phosphate dehydrogenase (G6PD) deficiency who was admitted with malaria and a chest infection. He has developed jaundice and haemolytic anaemia after starting some medications this morning.

Which of these medications are most likely to have precipitated his crisis?

A 32-year-old woman attends 8 days after returning from a Safari holiday in Uganda with headache, fever, muscle pains and malaise. She has no past medical history and is not taking any other medications.

Her temperature is 39.5ºC, blood pressure 100/70 mmHg, heart rate 110/min, respiratory rate 20 breaths/min, oxygen saturation 98% on air. Her blood sugar is 2.8 mmol/L.

Her blood film shows P. falciparum with 5% parasitaemia

How would you treat her?

The MOA of antiprotozoal Chloroquine is blockage the detoxification of heme into hemozoin, thereby allowing for toxic heme accumulation in the plasmodia

Sulfa Drugs and Antimalarials are types of drugs that classically cause oxidant stress in G6PD Deficiency.

Chloroquine is an anti-plasmodial commonly used for prophylaxis against sensitive Plasmodium spp.

A 32-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a prenatal visit. The patient intends to travel next month to Mozambique to visit her grandmother. Which of the following drugs is most suitable for pre-exposure prophylaxis against malaria?

A 29-year-old woman presents with high-grade fever, headache, and muscle pain. A week ago, she returned from India. She took a single dose of chloroquine 1 week before her trip and once-weekly thereafter. Her last dose was 2 days ago. She has no history of a serious illness. Her temperature is 39.3°C (102.7°F), pulse is 102/min, respirations are 22/min, and blood pressure is 112/78 mm Hg. Physical examination shows jaundice. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Her hemoglobin concentration is 10 g/dL. A peripheral blood smear shows fragmented erythrocytes and occasional ring-shaped inclusion bodies within RBCs. Which of the following is the most likely cause of infection in this patient?

A 55-year-old man presents with headache, fever, chills, shortness of breath, and abdominal pain for 1 week. He also feels tired and nauseous. He returned from a trip to Botswana 2 weeks ago. He has type 2 diabetes mellitus. His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination shows jaundice. A few scattered inspiratory crackles are heard in the thorax. The liver is palpated 2 cm below the right costal margin. Laboratory studies show:

Hemoglobin: 9.2 g/dL

Leukocyte count: 9,400/mm3

Platelet count: 90,000/mm3

LDH: high

Glucose: 69 mg/dL

Bilirubin : Total 4.2 mg/dL

AST: 79 U/L

ALT: 90 U/L

Urine: Blood 3+ Protein trace

Arterial blood gas analysis on room air shows a pH of 7.31.

Which of the following is the most appropriate next step in management?

Three days after starting a new drug for malaria prophylaxis, a 19-year-old college student comes to the physician because of dark-colored urine and fatigue. He has not had any fever, dysuria, or abdominal pain. He has no history of serious illness. Physical examination shows scleral icterus. Laboratory studies show a hemoglobin of 9.7 g/dL and serum lactate dehydrogenase of 284 U/L. Peripheral blood smear shows poikilocytes with bite-shaped irregularities. Which of the following drugs has the patient most likely been taking?

A 23-year-old man comes to the physician because of a 1-week history of muscle ache, fatigue, and fever that occurs every 2 days. He recently returned from a trip to Myanmar. A peripheral blood smear shows erythrocytes with brick-red granules. The physician recommends a combination of two antimicrobial drugs after confirming normal glucose-6-phosphate dehydrogenase activity. Which of the following is the most appropriate rationale for dual therapy?

A 46-year-old man comes to the physician because of a 1-week history of headache, muscle pain, and recurrent fever spikes that occur without a noticeable rhythm. Two weeks ago, he returned from a 5-week-long world trip, during which he climbed several mountains in India, Africa, and Appalachia. Chemoprophylaxis with chloroquine was initiated one week prior to the trip. Physical examination shows jaundice. The spleen is palpated 2 cm below the left costal margin. His hemoglobin concentration is 10 g/dL. A photomicrograph of a peripheral blood smear is shown. Which of the following agents is the most likely cause of this patient's findings?

A 24-year-old man is admitted to the Emergency Department with breathing difficulties and confusion three weeks after returning from a holiday in Cambodia. His partner says he has had 'the flu' for the past two weeks. A blood film is positive for malarial parasites and a chest x-ray and arterial blood gases suggest acute respiratory distress syndrome. A diagnosis of severe falciparum malaria is suspected. What is the treatment of choice?

A 58-year-old caucasian male originally from the United Kingdom (UK) now living in East Africa has returned to the UK on holiday. He has become unwell in the last two days, complaining of a headache, rigors, vomiting, fever, abdominal pain and passing little amounts of dark red urine. On examination, there is hepatosplenomegaly, jaundice and anaemia. Urinalysis reveals blood only and microscopy showed no red cells. Of the following options, what is the most likely diagnosis?

A 30-year-old man has just returned to the UK after visiting Kenya. He did not take any anti-malarials during his visit and received multiple mosquito bites. He is pyrexial but stable at present. Malaria is confirmed with a rapid antigen test. You are waiting for the rest of his test results. Which of the following findings would suggest that he should be treated as having severe malaria?