A 27 years old female, returned from Africa 3 weeks ago, got intermittent high fever for 1 week with chills and shivering, sweating after temperature drop to normal, then symptoms resolved. The cycle was repeated after 6 to 7 hours. She did not get better after taking chloroquine for 3 days. Physical examination: pulse 92 beats/min, blood pressure 110/60mmHg, poor mental state, slightly pale conjunctiva, normal breath sounds, heart rate 92/min, soft abdomen, no tenderness or rebound tenderness, normal liver but splenomegaly. Laboratory tests: blood: WBC 7.5×109/L, neutrophils 75%, lymphocytes 25%, hemoglobin 100g / L; Urinalysis: urobilinogen (-), bilirubin(±). (1) What’s the most likely diagnosis?
A 27 years old female, returned from Africa 3 weeks ago, got intermittent high fever for 1 week with chills and shivering, sweating after temperature drop to normal, then symptoms resolved. The cycle was repeated after 6 to 7 hours. She did not get better after taking chloroquine for 3 days. Physical examination: pulse 92 beats/min, blood pressure 110/60mmHg, poor mental state, slightly pale conjunctiva, normal breath sounds, heart rate 92/min, soft abdomen, no tenderness or rebound tenderness, normal liver but splenomegaly.
Laboratory tests: blood: WBC 7.5×109/L, neutrophils 75%, lymphocytes 25%, hemoglobin 100g / L; Urinalysis: urobilinogen (-), bilirubin(±).
(1) What’s the most likely diagnosis?
(2) What’s the evidences for diagnosis of the disease?
(3) How to deal with the patient?
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