Tuesday, June 23, 2015

Case of the Week 354

This week's case just came through our lab this morning! These peripheral blood specimens are from a 30 year old male, originally from South Africa, who presented to the Emergency Department after several days of fever. He was emergently treated and is fortunately doing well now.






Diagnosis?

15 comments:

Anonymous said...

Babesia

Julio said...

I would say P.falciparum since you mostly see early phases (rings) and none trophozoites and only 1 schizont

Anonymous said...

P. falciparum including a schizont. He must have some immunity.

Anonymous said...

Unreal and amazing he'd survive -sounds like typical severe case in the US as someone from Africa and goes home to visit but doesn't act like a traveler assuming is like the locals and doesn't take malaria drugs.

Anonymous said...

Wow, four respondents already. With so many ring forms, multiple rings in a red cell, head phones and the small size of the rings, all clues are consistent with a P. falciparum heavy infection. There is also a schizont which indicates that the infection may not be newly acquired.
Our hope is that the plasmodium is not drug resistant.

Florida Fan

Anonymous said...

Plasmodium falciparum

-ring forms seen
-double chromatin seen
-multiple infections seen
-schizont with +/- 19 merozoites

Wan Hafiz

sandy said...

P falciparum...there's going to be SOME ! hemolysis... BTW, i can't decipher what the big blue structs. in figs 1 & 2 are ?

Anonymous said...

I am going to be in the minority on this one, I think Babesia. Rings are less than 1/4 of the RBC, and the chromatin is more consistent with Babesia than Plasmodium. I am looking around for schizont pics of Babesia, I think in horses and dogs they form in the lymphocytes...but not sure about humans..

Lee

sandy said...

Interesting ! yes, at places, the rings do seem to resemble Babesia.

Found this art.; it says: In comparison with Plasmodium, Babesia does not cause pigment in erythrocytes, nor does it produce schizonts or gametocytes

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702012000500022

however, have no personal experience... !!

Anonymous said...

Are the figs. 1 & 2 thick smears?
In fig 2 you can see some pigment in the center.

-HLCM fan

Bobbi Pritt said...

Yes, figures 1&2 are thick films, so the blue-purple blobs are leukocytes. Sorry I didn't specify!

Anonymous said...

Indeed, Babesia does not produce malarial pigment, schizont nor gametocyte.
Another fact is that, with Babesia we do see extra erythrocytic as well as intra erythrocytic parasites. Malaria parasites are intra erythrocytic.

Florida Fan

Anonymous said...

I stand corrected. Plasmodium falciparum. Looking more closely there are the larger more rounded delicate falciparum, and no extracellular. Also on my internet searches, I only saw what looked like schizonts in lympocytes in horses.

Lee

sandy said...

tanx Bobbi !
@Lee : Babesia disc was a learning !

Anonymous said...

Plasmodium falciparum, heavy infection.
in picture 3 you can see a schizont with 16 merozoids meaning that there can be sequistration in the capilaries.
Haste is of the essence !