The patient is a 70-year-old woman who presented with 2 weeks of fever, chills, and progressive jaundice. She had received an orthotopic liver transplant 3 years prior. On admission, she was noted to have acute renal failure and she was started on antibiotics for a presumed urinary tract infection. However, peripheral blood films showed the following:
Identification?
14 comments:
I vote P. falciparum -- lots of small rings in small RBCs.
Plasmodium falciparum
Vivax.
Most likely falciparum given multiple infections of erythrocytes and small, lacy delicate parasites. Would be concerned re: dual infection with vivax as some of the parasitized cells seem to have rings a bit mature for falciparum (but then again this lady has had a transplant).
Musigny55
babesia
Looking like Babesia. Bottom image, lower right corner is trying to be a 'Maltese Cross'.
Babesia microti.... Well Babesia a lot more likely in the US for a non-traveler, and B. microti and renal failure go together. The first micrograph has what looks like a classic falciparum young ring (lower right first panel) which steered me away from Babesia, but maybe the gem of this case is how one can be mislead. If falciparum the patient should be nearly dead with this many infected cells! think I went down the wrong path and agree Babesia.
Babesia
I'll go with Babesia
P. vivax: reactivation of hypnozoites from her liver transplant.
The morphology of the trophozoites gives vivax it's name – "living."
Babesia. Multiply infected cells are typical. Probably transfusion-acquired. With this heavy parasitemia in falciparum she'd be dead.
Babesia fits better than Plasmodium. In heavy malaria infection, the ratio of single to multiple infection would be much higher. The rings of P. falciparum are much finer, so we would need to invoke partial treatment or poor slide processing.
...oh of course, the classical Plamodium spp. I am very familiar with these guys. They present to me like P. falciparium. I hope treatment was successful and should last for up to 21 days. Patient should be advice to return for a control.
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