BLOOD SMEAR AND RDT NEGATIVE PATIENTS

Patients who have a negative malaria test (most likely, if RDT is used) do not have malaria so other causes of fever have to be investigated for appropriate treatment.

  • Re-assess patient history, clinical signs and laboratory results. Consider other frequent causes of fever such as:
    • If running nose, sore throat and cough: viral upper respiratory infection
    • If swollen tonsils with exudate on it: tonsilitis
    • If ear pain and discharge: otitis
    • If cough, rapid breathing and difficulty in breathing: pneumonia
    • If urinary symptoms: urinary tract infection
    • If vomiting, diarrhoea and abdominal pain: gastroenteritis
    • If skin rash: measles or other viral rash
  • If malaria is still suspected, investigate according to the flowchart below
    • If signs/symptoms of severe malaria, RDT and blood slide negative but no other diagnosis is found, consider treating for malaria anyway but repeat RDTs after 24 hours to confirm
    • If RDT and blood slide negative, no signs of other illness and no signs of severe sickness (patient has no danger signs) treat symptomatically with antipyretics, advise patient to return immediately if condition worsens or in 2 days if fever persists.

Possible reasons for false negative tests (test is negative but patient has malaria):

  • Low peripheral parasitaemia
  • Technical error in performing the test or test reagents that are out of date
  • Sequestration of parasites in the internal organs
  • Having already taken antimalarial drugs, inadequate or incomplete dose: this affects only microscopy, while RDT remains positive even if the patient has already taken an antimalarial
  • Using prophylactic treatment for malaria