Monday, January 25, 2010

Case of the Week 103

The following peripheral blood film was obtained from a patient living in Missouri. Besides being an outdoorsman, he had traveled extensively in the past year, and visited many parts of Africa and Asia.







Diagnosis?

7 comments:

Anonymous said...

this looks most, at this resolution anyhow, like a case of babesiosis, due to the high degree of plieomorphism of the parasites. Could there be falciparum or another form of malaria as well? I'd like more history -- how recent was his international travel -- and to be able to examine more fields at higher-power as well; I can;t really distinguish a second populatoion but this is the sort of patient I'd send for a PCR and antigen test if available.

Alasdair Hill said...

interesting.... a P. falciparum infection with that high a parasitemia surely he would have presented much much earlier than 'in the past year' after returning from Africa/Asia?

Plus these trophozoites are irregular in shape (double plus you'll be lucky to see some in the peripheral blood if its P.f).

The South/Mid West is a common homeplace for Babesia right? I'll plug for that based on blood smear.

Kathy said...

I agree with Babesia sp.

Scott said...

Babesiosis

Anonymous said...

I don't think that P. falciparum is ruled out. I think I see applique forms...although I do see a "doublet". With this degree of parasitemia he would be very sick if it were P. falciparum. Ambivalent in VT.

Salbrent said...

Babesia and very small rings
What was the parasitemia %?

Parasite Gal said...

To answer Salbrent's comment, the percent parasitemia was 40! Not that surprising, considering that this patient did not have a spleen.