2nd August 2023

A 74 year old man presents with an 8 day history of fevers, malaise, and generalised body aches and pains.

A 74 year old man presents with an 8 day history of fevers, malaise, and generalised body aches and pains. He takes metformin for diabetes and recently returned from a trip to Zimbabwe.

Observations show a temperature of 40.2ᵒC, HR 122 bpm, BP 132/87 mmHg and RR 22/min. His blood glucose is measured as 3.1 mmol/L, although he is asymptomatic of this. A rapid diagnostic test for malaria comes back positive.

What single feature above distinguishes this presentation of malaria as ‘severe’?

Select the SINGLE most appropriate option from the list below. Select ONE option only.