Malaria in Maryland

Since COVID I’ve been semi-regularly reading ProMED emails digests. ProMED aggregates world wide infectious disease reports. They were the first to report on COVID-19 and a number of other outbreaks.

Last week they reported on a case of Malaria in Maryland. Which doesn’t seem too alarming, but I found interesting in any case.

Without direct exposure to infectious disease response, it’s always interesting to read these kinds of reports. It’s helps me calibrate my general bias that “better diagnostic tools will solve everything”.

In this case an individual had a fever for 7 days. So they admitted them and run some basic blood tests. These showed they had anemia (low red blood cell count), thrombocytopenia (low platelet count), hyperbilirubinemia (jaundice), and intraerythrocytic parasites (how exactly they measure that is less clear to me).

This raised concerns of babesiosis or malaria. Babesiosis is caused by a parasite carried by ticks.

At some point in the previous N months the patient had been bitten by a tick. So they figured it was probably that and started treatment.

A couple of days later, they looked at the smears taken at the time of admission and decided that maybe they kind of look like malaria? (Plasmodium falciparum)

But they weren't sure. So they just kept treating for Babesiosis and discharged the patient.

Another 5 days later (we’re now 11 days after admission, and 18 days since disease onset?). Someone else looked at the smear.

They decided it was worth running some tests. Among other things they used Abbott BinaxNOW Malaria, and qPCR tests. All these appear to have come back positive for Malaria… which they then treated for.

It’s worth noting that the Abbott test costs ~$50. So here a cheap effective test was available, but it just wasn’t part of their standard treatment workflow.

I kind of get it, you’re not really expecting Malaria in Maryland. But here they suspected it might be Malaria and contacted the CDC 2 days after admission. Why not spend the $50 on a test?

Overall, this leaves me with the impression that it will require something of a cultural shift to gain wider adoption for diagnostic testing. Particular the more advanced sequencing based diagnostic tests I’m a fan of.

While cases like the one above show they clearly have value. Driving adoption seems like it’s going to be an uphill struggle.