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 000, Number 000, April 2025, pages 000-000

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