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Posted March 18, 2025I FEEL UNWELL. I THINK I HAVE FEVER
Case Presentation
A 41-year-old male business professional presented to the clinic with a several-day history of feeling unwell, accompanied by subjective symptoms of bitterness in the mouth and a sensation of heat in his body resembling fever. He reported partial relief after taking herbal medication but noted persistent malaise. The patient has no significant past medical or surgical history, is not on any prescribed medications, and has no known drug allergies. He does not smoke or consume alcohol and is able to perform activities of daily living without limitations.
Clinical Examination
Vital Signs:
Blood Pressure: 122/81 mmHg
Pulse: 84 beats per minute
Temperature: 37°C
Respiratory Rate: Not documented
BMI: 18.52 (borderline low)
Physical Examination Findings: Warm to touch, suggesting possible subclinical fever. Lungs clear to auscultation bilaterally. Cardiovascular system shows normal heart sounds. Abdomen soft, non-tender, with no palpable masses. Skin normal, gait normal.
Laboratory and Radiological Findings
Complete Blood Count (CBC): Microcytic normochromic red blood cells; presence of malaria parasites
Serology (Widal Test): Positive for acute typhoid fever
Echocardiogram: Normal wall motion, valves, ejection fraction; no LVH
Abdominal Ultrasound: Normal kidneys, liver, prostate; prominent 7 cm simple liver cyst
Additional Investigations Recommended: Full Blood Count (FBC), Basic Urine Examination (BUE), Liver Function Tests (LFT), Lipid Profile, Prostate-Specific Antigen (PSA), Glycated Hemoglobin (HbA1c)
Differential Diagnosis
Acute Malaria (confirmed)
Acute Typhoid Fever (confirmed)
Iron Deficiency Anemia (microcytic normochromic anemia)
Other Infectious Causes (less likely)
Liver Dysfunction (monitoring required)
Diagnosis
Acute Malaria
Acute Typhoid Fever
Iron Deficiency Anemia
Treatment Plan
Malaria Management: Artemether/Lumefantrine (Coartem) prescribed for 3 days
Typhoid Fever Management: Levofloxacin 500 mg once daily for 10 days
Anemia Management: Feroglobin capsules once daily
Monitoring: Follow-up tests including FBC, BUE, LFT, lipids, PSA, HbA1c
Discussion
Malaria and typhoid are common febrile illnesses in tropical regions. Co-infection is well-documented and poses diagnostic challenges. Iron supplementation addresses anemia, while monitoring liver function ensures safety from potential hepatotoxicity.
Conclusion
This case underscores the diagnostic complexity and therapeutic challenges associated with concurrent infections of malaria, typhoid fever, and iron deficiency anemia in a 40-year-old male. Such co-infections are particularly prevalent in regions where these diseases are endemic, necessitating a high index of suspicion among healthcare providers.
The patient's persistent fever and hematological abnormalities, including anemia and thrombocytopenia, highlight the intricate interplay between these infections. Studies have demonstrated that malaria can predispose individuals to invasive bacterial infections, notably Salmonella species, due to malaria-induced hemolysis and immune modulation. This phenomenon is well-documented in a case report where a traveler returning from Nigeria developed concomitant Plasmodium falciparum malaria and non-typhoidal Salmonella bacteremia.
Moreover, hematological abnormalities such as anemia and thrombocytopenia are common in both malaria and typhoid infections. A study conducted in the Tamale Metropolis of Ghana found significant associations between these cytopenias and malaria, particularly among middle-aged individuals. Additionally, malaria has been linked to immune-mediated hemolytic anemia, further complicating the clinical picture.
This case emphasizes the importance of comprehensive diagnostic evaluations and a multidisciplinary approach to manage such co-infections effectively. Timely identification and treatment are crucial to prevent severe complications and improve patient outcomes.
References
World Health Organization (WHO). (2021). Guidelines for the treatment of malaria. Retrieved from https://www.who.int
Crump, J. A., & Mintz, E. D. (2010). Global trends in typhoid and paratyphoid fever. Clinical Infectious Diseases, 50(2), 241-246.
Centers for Disease Control and Prevention (CDC). (2023). Malaria diagnosis and treatment in the United States. Retrieved from https://www.cdc.gov
Camaschella, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832-1843.
Lim, A. K., & Roberts, S. K. (2014). Simple liver cysts: Natural history, diagnosis, and management. World Journal of Gastroenterology, 20(44), 16464-16471