How should fever in a returning traveler from a malaria-endemic region be approached?

• A. Consider malaria; obtain thick and thin blood smears or rapid diagnostic tests; start empiric antimalarial therapy if suspicion is high and notify public health.
• B. Assume malaria; obtain thick and thin blood smears or rapid diagnostic tests; start empiric antimalarial therapy if suspicion is high and notify public health.
• C. Malaria cannot be transmitted by travelers; no testing needed.
• D. Treat with antiretroviral therapy.

Answer: (B)

The key idea is to have a high index of suspicion and act quickly when a fever appears in a person returning from a malaria-endemic area. Malaria can be life-threatening and often presents with nonspecific fever, so you should promptly obtain diagnostic tests—thick and thin blood smears or malaria rapid diagnostic tests—to confirm. If the clinical suspicion is high, start empiric antimalarial therapy without waiting for test confirmation to avoid delay that could worsen outcomes. Public health notification is important because malaria is a notifiable infectious disease in many settings. While testing is essential, the emphasis is on not delaying treatment in high-suspicion cases. It’s also important to recognize that malaria can be transmitted by travelers, unlike treatments like antiretrovirals which are for other diseases.