What is the recommended action if suspicion for malaria is high in a returning traveler?

• A. Never start empiric therapy before confirmatory testing.
• B. Treat with antibiotics.
• C. Only treat after positive smear.
• D. Start empiric antimalarial therapy if suspicion is high and notify public health.

Answer: (D)

When malaria is strongly suspected in a returning traveler, act quickly with treatment. Early intervention is crucial because Plasmodium falciparum can progress to life-threatening illness, and relying on confirmatory testing alone can delay needed therapy. Blood smears and rapid tests may be negative early in infection, so starting empiric antimalarial treatment while awaiting confirmation helps prevent deterioration. Antibiotics won’t treat malaria, since it’s caused by a parasite. Additionally, malaria is often a notifiable disease, so informing public health authorities is important for surveillance and control. Therefore, the recommended action is to start empiric antimalarial therapy if suspicion is high and notify public health.