Pyrexia, Jaundice and AKI

🗒️ Question

A 29 year old woman presents to the emergency department with a 3 day history of fever, headache and fatigue. She recently returned from a 2 week business trip to Kenya and her symptoms started a few days after returning. On examination, her temperature is 38.9°C, pulse 105 bpm and she is slightly confused. Blood pressure is 100/60 mmHg and she appears jaundiced.

Lab test results show:

• Haemoglobin: 10.0 g/dL (13.8–17.2)

• Platelets: 95 x 10^9/L (150–400)

• Bilirubin: 50 µmol/L (3–17)

• Urea: 12.5 mmol/L (2.5–7.8)

• Creatinine: 180 µmol/L (62–106)

• Blood film: Plasmodium falciparum trophozoites seen

What is the most appropriate initial management for this patient?

(A) Oral quinine and doxycycline
(B) Oral atovaquone-proguanil
(C) Intravenous artesunate
(D) Intravenous quinine
(E) Oral mefloquine