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

Workup

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Media Gallery

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.

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Author

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

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

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Med Learning Group<br/>Received research grant from: Regeneron.

Coauthor(s)

Ryan Q Simon, MD Infectious Disease Specialist, Wright State Physicians, Wright State University School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

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, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

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, Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, South Carolina Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

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

Findings	P falciparum	P vivax	P ovale	P malariae
Only early forms present in peripheral blood	Yes	No	No	No
Multiply-infected RBCs	Often	Occasionally	Rare	Rare
Age of infected RBCs	RBCs of all ages	Young RBCs	Young RBCs	Old RBCs
Schüffner dots	No	Yes	Yes	No
Other features	Cells 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.

Malaria Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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