A 38-year-old woman presents to the Emergency Department with a 4-day history of fever, severe headache, myalgia, and a rash that appeared yesterday. She returned from a 2-week holiday in Thailand 5 days ago. She did not take malaria prophylaxis. She describes the headache as retro-orbital (behind the eyes) and reports severe joint and muscle pain.
On examination:
- Temp 39.1°C, HR 94, BP 105/68. Conjunctival injection, maculopapular rash on trunk and limbs sparing palms and soles, mild hepatomegaly, positive tourniquet test.
Blood tests show:
- WBC: 2.8 × 10⁹/L (leucopenia)
- Haemoglobin: 14.1 g/dL
- Platelets: 95 × 10⁹/L (thrombocytopenia)
- Haematocrit: 42%
- ALT: 156 U/L
- AST: 188 U/L
What is the most appropriate management for this patient?
A
IV ceftriaxone, blood films, admit for monitoring
B
Paracetamol, oral hydration, discharge with safety netting
C
Admit, supportive care, serial haematocrit and platelets
D
IV artesunate, urgent blood films, infectious diseases team
E
Platelet transfusion, IV antibiotics, ICU admission