Thursday, June 2, 2011

Case of the Week 163

The patient is a 40 year old professor who had recently taken a trip to Brazil with 15 of his students. During his trip, he and his students took oral malaria prophylaxis, used an insecticide treated bednet while sleeping, and applied DEET to exposed skin during the day. However, one of the 15 students came down with "malaria" in March. The professor then presented with night sweats (but no fever) and the astute physician ordered a peripheral blood exam for parasites. The following are representative images from the blood films:






Identification?
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8 comments:

  1. cebumdJune 6, 2011 at 4:31 AM

    Plasmodium vivax trophozoites?

    ReplyDelete
  2. KanootJune 6, 2011 at 7:25 AM

    Ameboid trophozoite (pic1, 3-4)
    Purplish Male gametocyte (pic2)
    Schuffner dot seen
    >> Plasmodium vivax

    ReplyDelete
  3. KathyJune 6, 2011 at 8:20 AM

    I agree with P. vivax

    ReplyDelete
  4. Neuro_NurseJune 6, 2011 at 9:43 AM

    P. vivax

    The CDC recommends mefloquine, doxy, or atovaquone/proguanil for malaria prophylaxis in Brazil. I can’t from the history tell how long after returning to the U.S. the student became symptomatic, but noncompliance with malaria prophylaxis is one of the common reasons travelers develop malaria after leaving an endemic area.

    Also, since the primary prophylactic drugs are active against trophozoites and not sporozoites or hypnozoites, it’s possible that this is a reactivation of P. vivax hypnozoites.

    The treating clinician may want to consider terminal prophylaxis with primaquine after ruling out G6PD deficiency.

    ReplyDelete
  5. MicrobeManJune 6, 2011 at 11:39 AM

    I concur, Plasmodium vivax.

    ReplyDelete
  6. JoJune 8, 2011 at 2:10 PM

    I also think of Plasmodim vivax trophozoites.

    ReplyDelete
  7. AnonymousJune 8, 2011 at 2:46 PM

    I also agree with P. vivax

    ReplyDelete
  8. AnonymousJune 8, 2011 at 4:55 PM

    I'm on the P. vivax bus: enlarged cells, stippled, non-compact trophs, good epidemiology.

    ReplyDelete