[Diagnosis of malaria in general practice: dealing with uncertainty].
Malaria is the disease to exclude when dealing with a patient coming back from an endemic area with fever. We need reliable diagnostic tools with negative likelihood ratio (LR-) close to zero (-> high negative predictive value). Ideally, a microscopical examination (ME) (thick and thin film) should be done, with or without a rapid diagnostic test (RDT). When the ME is not immediately available, an RDT can be done in the practice office and the ME delayed for 6-12 hours, provided there is no danger sign or thrombopenia. Indeed, the LR- of RDT being of 0.08 (estimated in a meta-analysis of RDT in non-immune travelers), the probability of falciparum malaria is 1% after a negative RDT. When the RDT is positive, the patient should always be treated with an anti-malarial, even if the ME is negative.
Genton
B
B
Centre de vaccination et de médecine des voyages Policlinique médicale universitaire 101 I Lausanne. Blaise.genton@hospvd.ch
D'Acremont
V
V
D003663:Decision Trees; D019353:Endemic Diseases; D005194:Family Practice; D006801:Humans; D008288:Malaria / Q000175:diagnosis*; D014195:Travel