ABSTRACT
A 31-year-old woman returned 3 months ago from a long holiday in the Middle East and North Africa, where she travelled widely and slept in a tent or in cheap hotels. She gives a 2-week history of fever, anorexia and abdominal discomfort. She has taken malaria prophylaxis. There is no history of diarrhoea or constipation. On examination, she is pale but not jaundiced. There is no lymphadenopathy, but the spleen is palpable 8 cm below the left costal margin, and the liver is also clinically enlarged. Investigations show
