Missed malaria diagnosis leads to man’s death

A 19-year-old man died after a missed malaria diagnosis, a week after testing positive for Covid-19.

According to a December communiqué of the National Institute for Communicable Diseases (NICD), the man tested positive for Covid-19 but healthcare workers didn’t test him for malaria.

Nine days after his Covid-19 diagnosis, he went to the clinic and complained of a headache and fever. Two days later, he went to a general practitioner and presented with the same symptoms.

The report states: “At this stage confusion and jaundice were noted, and he was admitted to hospital. Initial assessment was of fulminant hepatitis. He was apyrexial (no fever), with low blood pressure and depressed level of consciousness. The platelet count was low; he had a raised total bilirubin level and was severely acidotic, with acute renal failure.”

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A rapid malaria test was done and it was positive. Quinine was administered intravenously.

“The patient developed progressive respiratory distress requiring intubation; the clinical condition deteriorated and he died within eight hours of admission. This is one of several recent cases where the current focus on Covid-19 has obscured or diverted attention from a concurrent malaria infection, with tragic consequences. At this time of year when there are increases in both travel and malaria transmission, it is important to remember about the risk of malaria and the danger of missing the diagnosis,” the NICD said.

Same early symptoms

The NICD warned health professionals that Covid-19 and malaria exhibited the same early symptoms, such as fever, a headache, fatigue, muscle and joint pain, and respiratory difficulties.

The disease, which is carried by mosquitoes, is endemic in Mpumalanga, Limpopo and KwaZulu-Natal during the summer months. Gauteng receives imported malaria cases.

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“Unrecognised and untreated malaria can rapidly progress to severe illness with a high mortality. It is therefore mandatory that any persons presenting with fever and flu-like illness, if they are resident in, or have travelled within the last six weeks from, a malaria-risk area, regardless of suspected Covid-19 condition, be checked for malaria by rapid diagnostic test or blood smear microscopy, and the results obtained urgently,”  the report states.

The NICD also warned that some malaria vector mosquitoes were transported accidentally, and transmitted malaria outside their normal habitats to people without travel histories.

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