QUESTION

My child (age 5 at time) was bitten by something in Mexico that looked like a mosquito bite. About 7 days later we were home in the US and she developed high fever, headache, chills,sweating at night, extreme fatigue,abdominal pain, and swollen lymph nodes in neck. She had a fever for 40 days! I took her to the pediatrician almost every other day and had immediately informed them of the bite in Mexico and asked if they could test her for malaria. They laughed at me and said that is not high malaria area.

Her wbc was 30,000ish and liver enzymes 1000–tons of other blood work got lost. I had researched and agreed but told them it still exits there even if it is low. So 3 years later she still has swollen lymph nodes in neck that are bigger and now in the axillary and groin area, always sweats in the middle of the night, pale, and very tired. Dr. tells me not to worry about the lymph nodes but it is hard not to. I have bypassed her finally and talked with an infectious disease doctor that suggested we get a lymphnode biopsy. We have an appt w/an hem/onc Dr in 5 days. If they were to biopsy a lymph node could it show Malaria this late or would it have to be the liver or could they do a blood smear this late? She also has had low amounts of myoglobin in her urine for about a year.

ANSWER

I replied to an earlier version of this post—reading your subsequent details, I think it is unlikely that the cause is malaria, but rather an infection or indeed another disorder which would result in elevated WBC and enlarged lymph nodes. A biopsy at this stage would not be able to diagnose malaria—a blood test would only reveal an active, blood-borne infection, which would be associated with high fever and other “typical” malaria symptoms. If your daughter is experiencing these (though fever/sweats at night are not particularly associated with malaria), a blood test could put your mind at rest by eliminating malaria as a cause. However your pediatrician will be better placed to discuss other possible diagnoses which correspond to the symptoms.