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.
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.
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.
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.
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.
ReplyDeleteinteresting.... 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?
ReplyDeletePlus 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.
I agree with Babesia sp.
ReplyDeleteBabesiosis
ReplyDeleteI 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.
ReplyDeleteBabesia and very small rings
ReplyDeleteWhat was the parasitemia %?
To answer Salbrent's comment, the percent parasitemia was 40! Not that surprising, considering that this patient did not have a spleen.
ReplyDelete