Monday, February 2, 2015

Case of the Week 335

This week's case was kindly donated by Dr. Gary Procop at Cleveland Clinic.

The patient is an otherwise healthy woman in her mid-50's who presented with fever and night sweats. Hematologic exam revealed a mild anemia, leukopenia and thrombocytopenia. The patient travels regularly to Central America and has exposure to exotic wildlife, but none of the animals to which she was exposed were ill.





Identification?

7 comments:

Anonymous said...

Babesia?

Tom Luke said...

I would include anaplasmosis in the differnetial.

Anonymous said...

Wow, a nice case of malaria.
First, the infected red blood cells are either normal in size or slightly smaller than the non infected red cells. This helps us eliminate P. vivax and P. ovale which have a predilection of reticulocytes.
Second, the absence of ring forms, including "headphones" and "appliques" and multiple infection in the same red cell help us rule out P. falciparum.
We can take the fact that the animals were not ill as an indication that this may not be an infection with P. knowlesi.
The remaining possibility is P. malaria with the young band form, a schizonte with about ten merozoites, a few band forms and a quasi "daisy" pattern of a mature schizonte.

Florida Fan

Arthur Morris said...

Likely to be Plasmodium malariae, which is endemic in certain areas of central and south America. Differential would be vivax and falciparum malaria (there is not much ovale in the America's ), Babesia and Anaplasma. Morphology and presence of schizonts suggests this is apicomplexan, ruling out Anaplasma. Presence of Haemozoin and lack of characteristic club shaped forms rules out Babesia, microcytic infection, characteristic 'flower' schizont and sparse infection suggests P.malariae.

Anonymous said...

P. malariae, cells small, small number of merozoites...Lee

tink said...

Looks like P. malariae

tink said...
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