Fatal Cerebral Malaria in a Returning Traveler: Challenges in Recognition, Treatment, and Resource Accessibility in the United States.

Malaria is a common febrile illness that can sometimes present as an acute potentially fatal disease if left undiagnosed or untreated. It is caused by an intra-erythrocytic infection from the Plasmodium parasite and transmitted by the female Anopheles mosquito. Symptoms are nonspecific, ranging from fevers, headache, malaise, myalgia, gastrointestinal distress to confusion, seizures or coma. Fever is the most characteristic feature of the illness and periodic febrile responses correspond to rupture of mature schizonts from erythrocytes. Diagnosis should be considered with anyone with fever of unknown origin regardless of travel history. Plasmodium falciparum is the most likely to cause severe malaria. Severe malaria is defined by the Centers for Diseases Control (CDC), when there is high burden of parasitemia and evidence of end organ dysfunction spanning across central nervous, cardiovascular, respiratory, renal and hematological systems. This entity needs prompt diagnosis and treatment. Despite recommendations and approval by the FDA, IV artesunate is not readily available at most hospitals in the United States.