Clin Infect Immun

Clinical Infection and Immunity, ISSN 2371-4972 print, 2371-4980 online, Open Access

Article copyright, the authors; Journal compilation copyright, Clin Infect Immun and Elmer Press Inc

Journal website https://cii.elmerpub.com

Case Report

Volume 10, Number 2, June 2025, pages 35-40

A Case of Severe Malaria With Disseminated Intravascular Coagulation in an American Missionary and Review of Current Treatment and Prophylaxis

↓ Figure 1. Peripheral blood smear demonstrating red blood cells infected with malaria parasites (0.6% of erythrocytes, or 28 × 10³ parasites/µL). Additional hematologic findings include moderate lymphocytopenia, consistent with a diagnosis of malaria.

↓ **Table 1.** Comparison of Significant Laboratory Values During Hospital Course
Serum/hematologic	Reference values [9]	Day 1^a	Day 3^b	Day 8^c
“L” signifies lab values below the reference range; “H” indicates values above the reference range. All blood drawings were performed at the same time of day (i.e., 1200, military time). ^aDay of hospital admission. ^bDay of IV artesunate administration. ^cDay of discharge. IV: intravenous; AST: aspartate aminotransferase; ALT: alanine aminotransferase; WBC: white blood cell.
Platelets (× 10³/µL)	150 - 350	92 (L)	25 (L)	127 (L)
Erythrocyte count, male (× 10⁶/µL)	4.5 - 5.9	5.07	4.65	4.02 (L)
WBC count (× 10³/µL)	4.0 - 10.0	3.2 (L)	4.7	6.1
Hemoglobin, male (g/dL)	14 - 18	16	14.7	12.4 (L)
Hematocrit, male (%)	42 - 50	46.2	42	36 (L)
Glucose, serum (mg/dL)	70 - 99	117 (H)	100 (H)	109 (H)
AST (U/L)	10 - 40	88 (H)	139 (H)	86 (H)
ALT (U/L)	10 - 40	101 (H)	125 (H)	170 (H)
Total bilirubin (mg/dL)	0.3 - 1.0	1.1 (H)	2.7 (H)	1.1 (H)
Sodium (mEq/L)	136 - 145	133 (L)	136	132 (L)
Potassium (mEq/L)	3.5 - 5.0	4	3.4 (L)	3.8

↓ Table 1. Comparison of Significant Laboratory Values During Hospital Course

Serum/hematologic

Reference values [9]

Day 1^a

Day 3^b

Day 8^c

“L” signifies lab values below the reference range; “H” indicates values above the reference range. All blood drawings were performed at the same time of day (i.e., 1200, military time). ^aDay of hospital admission. ^bDay of IV artesunate administration. ^cDay of discharge. IV: intravenous; AST: aspartate aminotransferase; ALT: alanine aminotransferase; WBC: white blood cell.

Platelets (× 10³/µL)

150 - 350

92 (L)

25 (L)

127 (L)

Erythrocyte count, male (× 10⁶/µL)

4.5 - 5.9

5.07

4.65

4.02 (L)

WBC count (× 10³/µL)

4.0 - 10.0

3.2 (L)

4.7

6.1

Hemoglobin, male (g/dL)

14 - 18

14.7

12.4 (L)

Hematocrit, male (%)

42 - 50

46.2

36 (L)

Glucose, serum (mg/dL)

70 - 99

117 (H)

100 (H)

109 (H)

AST (U/L)

10 - 40

88 (H)

139 (H)

86 (H)

ALT (U/L)

10 - 40

101 (H)

125 (H)

170 (H)

Total bilirubin (mg/dL)

0.3 - 1.0

1.1 (H)

2.7 (H)

1.1 (H)

Sodium (mEq/L)

136 - 145

133 (L)

136

132 (L)

Potassium (mEq/L)

3.5 - 5.0

3.4 (L)

3.8

↓ **Table 2.** Coagulation Profile and ISTH DIC Scoring
Parameter	Patient’s value	Typical DIC expectation	Points in ISTH DIC scoring (approximation)
A score consistent with DIC is 5 or greater [10]. Our patient scored either a 5 or 6, thus meeting the criteria for DIC. DIC: disseminated intravascular coagulation; ISTH: International Society on Thrombosis and Haemostasis; PT: prothrombin time; PTT: partial thromboplastin time.
Platelet count	25,000/µL	Often < 50,000/µL due to consumption	2
D-dimer	35.2 µg/mL	Significantly elevated (consistent with strong fibrin degradation)	3
Fibrinogen	302 mg/dL	Typically low in frank DIC (< 100 mg/dL); however, may be normal or elevated in early/compensated DIC or in acute-phase response	0
PT	14.4 s	Often prolonged; in prolonged by > 3 s compared to normal, this adds to the score	0 - 1 (depends on local reference ranges)
PTT	39 s	May be prolonged; however, less specific	-

↓ Table 2. Coagulation Profile and ISTH DIC Scoring

Parameter

Patient’s value

Typical DIC expectation

Points in ISTH DIC scoring (approximation)

A score consistent with DIC is 5 or greater [10]. Our patient scored either a 5 or 6, thus meeting the criteria for DIC. DIC: disseminated intravascular coagulation; ISTH: International Society on Thrombosis and Haemostasis; PT: prothrombin time; PTT: partial thromboplastin time.

Platelet count

25,000/µL

Often < 50,000/µL due to consumption

D-dimer

35.2 µg/mL

Significantly elevated (consistent with strong fibrin degradation)

Fibrinogen

302 mg/dL

Typically low in frank DIC (< 100 mg/dL); however, may be normal or elevated in early/compensated DIC or in acute-phase response

14.4 s

Often prolonged; in prolonged by > 3 s compared to normal, this adds to the score

0 - 1 (depends on local reference ranges)

PTT

39 s

May be prolonged; however, less specific