A 55-year-old man comes to the emergency department because of headache, fever, chills, shortness of breath, and abdominal pain for 1 week. He also feels tired and nauseous. He returned from a trip to Botswana 2 weeks ago. He has type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 30 years and drinks a glass of beer daily. His only current medication is metformin. His temperature is 39.3°C (102.8°F), pulse is 122/min, respirations are 28/min, and blood pressure is 109/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination shows jaundice. Peripheral blood smear shows intraerythrocytic Plasmodium falciparum. Which of the following is the most likely underlying cause of this patient's infection?

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Eductional Objective: Mefloquine chemoprophylaxis for malaria must be continued for 4 weeks after return from an endemic region to ensure the elimination of hepatic schizonts (which develop in the liver over 8-30 days).

A 55-Year-Old Man Comes to the Emergency Department Because of Headache