notesonly.in

A 28-year-old male farmer came to the outpatient clinic with high fever accompanied by shaking chills and severe sweating occurring every 48 hours for the past week. He also complained of stomach pain and passing loose, dark stools containing mucus and blood for 5 days. On physical examination, he was pale (pallor) and had mild yellow discoloration of the eyes (icteric sclera). His heart rate was high (110 beats/min) and body temperature was 102.5°F. On belly examination, his liver was enlarged and tender to touch (hepatomegaly). Laboratory tests showed: 1. Blood smear (thick and thin films): Revealed ring-stage forms of Plasmodium vivax inside red blood cells. 2. Stool microscopy: Showed motile trophozoites of Entamoeba histolytica containing ingested red blood cells. 3. G6PD enzyme levels: Normal. Diagnosis Reasoning: - The periodic high fever with shaking chills combined with ring-stage parasites on blood film confirms Plasmodium vivax malaria. - The bloody diarrhea with trophozoites containing ingested red blood cells confirms intestinal amoebic dysentery. Management Plan: 1. For Blood-Stage Malaria: Oral Chloroquine (10 mg/base/kg initial dose, followed by 5 mg/kg at 6, 24, and 48 hours) to rapidly clear parasites from red blood cells. 2. For Malaria Relapse Prevention: Oral Primaquine (0.25 mg/kg daily for 14 days) to kill sleeping liver forms (hypnozoites) after confirming normal G6PD levels. 3. For Tissue Amoebiasis: Oral Metronidazole (400 mg three times daily for 7 days) to kill tissue-invading amoebae. 4. For Luminal Amoebiasis: Oral Diloxanide furoate (500 mg three times daily for 10 days) after finishing Metronidazole to eradicate bowel cysts.