A clinical question for clinicians in Malawi and Scotland (and other places too). This week I saw a lady, 20 weeks pregnant, recently returned from sub-sarharan Africa, who presented with a cough, myalgia and a high temperature. Scotland is in the midst of the H1N1 pandemic and pregant ladies are at high risk of complications, so we have a low threshold for using anti-viral drugs. The decision to use these has to be made quickly, sometimes before laboratory confirmation is available. But how do we know it is not Malaria? Does the pattern of pyrexia give a clue? I’d be keen to hear from colleagues in Malawi how they approach this problem.
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