Malaria Differential Diagnoses

Updated: May 11, 2023
  • Author: William N Bennett, V, MD; Chief Editor: Michael Stuart Bronze, MD  more...
  • Print
DDx

Diagnostic Considerations

Malaria Differential Diagnosis

Malaria is the most common life-threatening cause of fever in a returning traveler from malaria-endemic countries. [35]  Given the potential for relapse or delayed primary infection from P vivax or ovale, malaria always should be ruled out if the patient has an epidemiologic travel link over the prior several months. Remeber that a consideration for malaria should occur for any fever in a traveler from an endemic area, as the disease may present with other ailments concomitantly, or the patient may experience unique malaria-related protean manifestations of their own.

Travel Timeline & Incubation Period

Etiologies of travel-related fever may be classified in a clinically useful fashion through the understanding of specific infectious diseases’ incubation periods. Once a proper timeframe of expected disease presentation is established, the list of differential diagnoses may be narrowed further by the geography of the patient’s itinerary and likely transmission risks. Below are lists of diseases associated with their usual incubation periods:

Incubation period < 14 days

  • Influenza 1-3 days
  • Chikungunya 2-4 days
  • Crimean Congo Hemorrhagic Fever 3-7 days
  • Zika 3-14 days
  • Arboviral encephalitis 3-14 days
  • Dengue 4-8 days
  • Legionellosis 5-6 days
  • Meningococcemia < 10 days
  • Rickettsia (spotted fever group) < 10 days
  • Malaria ( P vivax) 8-365 days (~1/2 present after 30 days)
  • Malaria ( P falciparum) 6-30 days
  • Leptospirosis 7-12 days
  • Typhoid & paratyphoid 7-18 days
  • Ebola & Lassa 7-21 days
  • Acute HIV 10-28 days

Incubation period 14-42 days

  • Typhoid & paratyphoid 7-18 days
  • Ebola & Lassa 7-21 days
  • Acute HIV 10-28 days
  • Malaria ( P falciparum) 6-30 days
  • Malaria ( P vivax) 8-365 days (~1/2 present after 30 days)
  • Amebic liver abscess weeks-months
  • Hepatitis A 28-30 days
  • Hepatitis E 26-42 days
  • Acute schistosomiasis 29-56 days

Incubation period >42 days

  • Malaria ( P vivax) 8-365 days (~1/2 present after 30 days)
  • Hepatitis E 26-42 days
  • Amebic liver abscess weeks-months
  • Acute schistosomiasis 29-56 days
  • Hepatitis B 90 days
  • Visceral leishmaniasis 2-10 months
  • Tuberculosis weeks (primary infection), years (reactivation)