Match each patient's clinical presentation and peripheral blood smear findings with the most appropriate definitive antimalarial treatment regimen.
- A 29-year-old journalist returning from Nigeria presents with confusion and jaundice. Vitals: T 39.8°C (103.6°F), BP 90/60 mmHg. Labs show creatinine 3.1 mg/dL. Smear reveals 11% parasitemia with crescent-shaped gametocytes and multiple rings per RBC.Immediate intravenous artesunate followed by a full oral course of artemether-lumefantrine once tolerating oral intake
- A 35-year-old aid worker returning from rural Honduras presents with severe chills followed by high fevers every 48 hours. Exam reveals splenomegaly. Smear shows enlarged, pale erythrocytes with fine red stippling and amoeboid trophozoites. Normal G6PD.Oral chloroquine phosphate therapy combined with a 14-day course of oral primaquine to eradicate dormant liver stages
- A 42-year-old tourist returning from Thailand presents with fever, headache, and myalgias. Vitals are stable, and labs show normal organ function. Smear shows 1.5% parasitemia with appliqué ring forms on the erythrocyte margins.Oral artemisinin-based combination regimen (e.g., artemether-lumefantrine) without the need for subsequent anti-relapse therapy
- A 50-year-old researcher returning from a chloroquine-susceptible Caribbean nation presents with fevers peaking every 72 hours. Exam is unremarkable between episodes. Smear demonstrates compact, band-like trophozoites inside normal-sized erythrocytes.Oral chloroquine phosphate monotherapy for a total of 3 days, as there is no latent hepatic phase
Answer
The correct matches synthesize the Plasmodium species identified via smear morphology, clinical severity, regional resistance patterns, and the presence of a hypnozoite phase to assign the definitive pharmacological regimen.
The correct pairings require precise synthesis of microbiologic findings (smear morphology), clinical status (severe vs. uncomplicated), and geographic resistance data. Severe P. falciparum requires IV artesunate. Uncomplicated CQ-resistant P. falciparum requires oral ACT. P. vivax requires CQ plus primaquine for hypnozoites. P. malariae requires only CQ.
Step-by-Step Solution
Key Concept
Diagnosis and targeted pharmacotherapy of malaria based on Plasmodium species morphology, clinical severity, geographic resistance patterns, and the presence of a hypnozoite phase.
Estimated Time:2m 30s