Malaria Differential Diagnoses

  • Author: Emilio V Perez-Jorge, MD, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Apr 10, 2012
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of malaria include the following:

  • Viral illness
  • Bacteremia
  • African trypanosomiasis
  • Amebiasis and amebic liver abscess
  • Brucellosis
  • Cholera
  • Collagen vascular disease
  • Enteric fever
  • Epidemic or louse-borne typhus
  • Food-borne illness or toxin
  • Hodgkin disease
  • Relapsing fever
  • Poliomyelitis
  • Schistosomiasis (acute Katayama fever)
  • Seizure disorder
  • HIV infection
  • Babesiosis
  • Plague
  • Q fever
  • Viral hemorrhagic fevers
  • Dengue Fever
  • Encephalitis
  • Gastroenteritis
  • Giardiasis
  • Heat exhaustion and heatstroke
  • Hepatitis
  • Hypothermia
  • Leishmaniasis
  • Mononucleosis
  • Otitis media
  • Pelvic inflammatory disease
  • Pharyngitis
  • Bacterial pneumonia
  • Immunocompromised pneumonia
  • Mycoplasma pneumonia
  • Viral Pneumonia
  • Salmonella infection
  • Sinusitis
  • Tetanus
  • Toxoplasmosis
  • Yellow fever

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Emilio V Perez-Jorge, MD, FACP  Staff Physician, Division of Infectious Diseases, Lexington Medical Center

Emilio V Perez-Jorge, MD, FACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Hospital Medicine, and South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas E Herchline, MD  Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, and Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Michael Stuart Bronze, MD Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Joseph Richard Masci, MD Professor of Medicine, Professor of Preventive Medicine, Mount Sinai School of Medicine; Director of Medicine, Elmhurst Hospital Center

Joseph Richard Masci, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Association of Professors of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Cox-Singh J, Davis TM, Lee KS, Shamsul SS, Matusop A, Ratnam S, et al. Plasmodium knowlesi malaria in humans is widely distributed and potentially life threatening. Clin Infect Dis. Jan 15 2008;46(2):165-71. [Medline]. [Full Text].

  2. Marchand RP, Culleton R, Maeno Y, Quang NT, Nakazawa S. Co-infections of Plasmodium knowlesi, P. falciparum, and P. vivax among Humans and Anopheles dirus Mosquitoes, Southern Vietnam. Emerg Infect Dis. Jul 2011;17(7):1232-9. [Medline].

  3. William T, Menon J, Rajahram G, Chan L, Ma G, Donaldson S, et al. Severe Plasmodium knowlesi malaria in a tertiary care hospital, Sabah, Malaysia. Emerg Infect Dis. Jul 2011;17(7):1248-55. [Medline].

  4. Malaria Surveillance — United States, 2010. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6102a1.htm?s_cid=ss6102a1_e. Accessed March 1, 2012.

  5. Centers for Disease Control and Prevention. Malaria. Available at http://www.cdc.gov/malaria. Accessed Sep 15, 2011.

  6. McGready R, Lee S, Wiladphaingern J, Ashley E, Rijken M, Boel M, et al. Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study. Lancet Infect Dis. Dec 12 2011;[Medline].

  7. Taylor SM, Parobek CM, Fairhurst RM. Haemoglobinopathies and the clinical epidemiology of malaria: a systematic review and meta-analysis. Lancet Infect Dis. Mar 22 2012;[Medline].

  8. [Guideline] Bailey JW, Williams J, Bain BJ, Parker-Williams J, Chiodini P. General Haematology Task Force. Guideline for laboratory diagnosis of malaria. London (UK): British Committee for Standards in Haematology. 2007;19. [Full Text].

  9. Rapid diagnostic tests for malaria ---Haiti, 2010. MMWR Morb Mortal Wkly Rep. Oct 29 2010;59(42):1372-3. [Medline].

  10. Wongsrichanalai C, Barcus MJ, Muth S, Sutamihardja A, Wernsdorfer WH. A review of malaria diagnostic tools: microscopy and rapid diagnostic test (RDT). Am J Trop Med Hyg. Dec 2007;77(6 Suppl):119-27. [Medline].

  11. Centers for Disease Control and Prevention. Notice to Readers: Malaria Rapid Diagnostic Test. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5627a4.htm. Accessed September 30, 2011.

  12. de Oliveira AM, Skarbinski J, Ouma PO, Kariuki S, Barnwell JW, Otieno K, et al. Performance of malaria rapid diagnostic tests as part of routine malaria case management in Kenya. Am J Trop Med Hyg. Mar 2009;80(3):470-4. [Medline].

  13. d'Acremont V, Malila A, Swai N, Tillya R, Kahama-Maro J, Lengeler C, et al. Withholding antimalarials in febrile children who have a negative result for a rapid diagnostic test. Clin Infect Dis. Sep 1 2010;51(5):506-11. [Medline].

  14. Mens P, Spieker N, Omar S, Heijnen M, Schallig H, Kager PA. Is molecular biology the best alternative for diagnosis of malaria to microscopy? A comparison between microscopy, antigen detection and molecular tests in rural Kenya and urban Tanzania. Trop Med Int Health. Feb 2007;12(2):238-44. [Medline].

  15. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. Nov 13 2010;376(9753):1647-57. [Medline]. [Full Text].

  16. US Food and Drug Administration FDA Approves Coartem Tablets to Treat Malaria. FDA. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149559.htm. Accessed April 8, 2009.

  17. Teuscher F, Gatton ML, Chen N, Peters J, Kyle DE, Cheng Q. Artemisinin-induced dormancy in plasmodium falciparum: duration, recovery rates, and implications in treatment failure. J Infect Dis. Nov 1 2010;202(9):1362-8. [Medline]. [Full Text].

  18. Tozan Y, Klein EY, Darley S, Panicker R, Laxminarayan R, Breman JG. Prereferral rectal artesunate for treatment of severe childhood malaria: a cost-effectiveness analysis. Lancet. Dec 4 2010;376(9756):1910-5. [Medline].

  19. Othoro C, Johnston D, Lee R, Soverow J, Bystryn JC, Nardin E. Enhanced immunogenicity of Plasmodium falciparum peptide vaccines using a topical adjuvant containing a potent synthetic Toll-like receptor 7 agonist, imiquimod. Infect Immun. Feb 2009;77(2):739-48. [Medline]. [Full Text].

  20. Richards JS, Stanisic DI, Fowkes FJ, Tavul L, Dabod E, Thompson JK, et al. Association between naturally acquired antibodies to erythrocyte-binding antigens of Plasmodium falciparum and protection from malaria and high-density parasitemia. Clin Infect Dis. Oct 15 2010;51(8):e50-60. [Medline].

  21. Olotu A, Lusingu J, Leach A, Lievens M, Vekemans J, Msham S, et al. Efficacy of RTS,S/AS01E malaria vaccine and exploratory analysis on anti-circumsporozoite antibody titres and protection in children aged 5-17 months in Kenya and Tanzania: a randomised controlled trial. Lancet Infect Dis. Feb 2011;11(2):102-9. [Medline].

  22. [Best Evidence] Briand V, Bottero J, Noël H, Masse V, Cordel H, Guerra J, et al. Intermittent treatment for the prevention of malaria during pregnancy in Benin: a randomized, open-label equivalence trial comparing sulfadoxine-pyrimethamine with mefloquine. J Infect Dis. Sep 15 2009;200(6):991-1001. [Medline].

  23. Briand V, Cottrell G, Massougbodji A, Cot M. Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J. Dec 4 2007;6:160. [Medline]. [Full Text].

  24. Piola P, Nabasumba C, Turyakira E, Dhorda M, Lindegardh N, Nyehangane D, et al. Efficacy and safety of artemether-lumefantrine compared with quinine in pregnant women with uncomplicated Plasmodium falciparum malaria: an open-label, randomised, non-inferiority trial. Lancet Infect Dis. Nov 2010;10(11):762-9. [Medline].

  25. Trape JF, Tall A, Diagne N, Ndiath O, Ly AB, Faye J, et al. Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study. Lancet Infect Dis. Dec 2011;11(12):925-32. [Medline].

  26. Centers for Disease Control and Prevention. Atlanta, GA: DHHS; 2009. Malaria and Travelers. Available at http://www.cdc.gov/malaria/travelers/index.html. Accessed Sep 15, 2011.

  27. The RTS,S Clinical Trials Partnership. First results of phase 3 trial of RTS,S/AS01 malaria vaccine in African children. N Engl J Med. 2011/Oct;365:[Full Text].

  28. White NJ. A vaccine for malaria (editorial). N Engl J Med. 2011/Oct;365:[Full Text].

  29. Centers for Disease Control and Prevention. Malaria Diagnosis and Treatment in the United States. Available at http://www.cdc.gov/malaria/diagnosis_treatment/index.html. Accessed Sep 15, 2011.

  30. Poespoprodjo JR, Fobia W, Kenangalem E, Lampah DA, Warikar N, Seal A, et al. Adverse pregnancy outcomes in an area where multidrug-resistant plasmodium vivax and Plasmodium falciparum infections are endemic. Clin Infect Dis. May 1 2008;46(9):1374-81. [Medline]. [Full Text].

  31. Carmona-Fonseca J, Alvarez G, Maestre A. Methemoglobinemia and adverse events in Plasmodium vivax malaria patients associated with high doses of primaquine treatment. Am J Trop Med Hyg. Feb 2009;80(2):188-93. [Medline].

 
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Malarial merozoites in the peripheral blood. Note that several of the merozoites have penetrated the erythrocyte membrane and entered the cell.
This micrograph illustrates the trophozoite form, or immature-ring form, of the malarial parasite within peripheral erythrocytes. Red blood cells infected with trophozoites do not produce sequestrins and, therefore, are able to pass through the spleen.
An erythrocyte filled with merozoites, which soon will rupture the cell and attempt to infect other red blood cells. Notice the darkened central portion of the cell; this is hemozoin, or malaria pigment, which is a paracrystalline precipitate formed when heme polymerase reacts with the potentially toxic heme stored within the erythrocyte. When treated with chloroquine, the enzyme heme polymerase is inhibited, leading to the heme-induced demise of non–chloroquine-resistant merozoites.
A mature schizont within an erythrocyte. These red blood cells (RBCs) are sequestered in the spleen when malaria proteins, called sequestrins, on the RBC surface bind to endothelial cells within that organ. Sequestrins are only on the surfaces of erythrocytes that contain the schizont form of the parasite.
Schema of the life cycle of malaria. Image courtesy of the Centers for Disease Control and Prevention.
Table 1. Histologic Variations Among Plasmodium Species
FindingsP falciparumP vivaxP ovaleP malariae
Only early forms present in peripheral bloodYesNoNoNo
Multiply-infected RBCsOftenOccasionallyRareRare
Age of infected RBCsRBCs of all agesYoung RBCsYoung RBCsOld RBCs
Schüffner dotsNoYesYesNo
Other featuresCells have thin cytoplasm, 1 or 2 chromatin dots, and applique forms.Late trophozoites develop pleomorphic cytoplasm.Infected RBCs become oval, with tufted edges.Bandlike trophozoites are distinctive.
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