Monday, July 29, 2019

Case of the Week 554

This week's case was generously donated by Florida Fan. The following are seen on Giemsa-stained thick and thin blood films. No history is immediately available. Diagnosis? Any additional information you would like?






13 comments:

Unknown said...

Place of residence n travel history.
I could see only dots.
The ring are missing.
I am not that expert at reading thick films.
What was the rapid diagnostic kit report??????

Dan said...

First impression: Babesia

Blaine A. Mathison said...

Initially I would say Babesia, based on the highly variable forms of the rings, including multiply-infected erythrocytes with very small, pleomorphic rings, and extracellular forms.

Still, in the absence of epi data, I'd keep Plasmodium falciparum in the differential (and note that if it was Pf, looks like the blood was not processed in a timely manner). That being said, if this was malaria in 'old blood', I would expect pigment to be present, which is never present with Babesia.

Marc said...

Presumptive Babesia unless I can ascertain more information.

Anonymous said...

Babesia, with a form of malaria in the differential.
BW in Vt

Sheldon Campbell said...

Agree with Blaine; not that I'd dare do otherwise. Pretty typical for Babesia, barring other travel history; note the 'streak' forms and extracellular merozoites.

Unknown said...

Babesia spp. Pear-shaped, a few parasites in the RBC, inside and outside RBCs, no pigment (haemozoin); additional info required required: ticks, forests, blood transfusion, splenectomy

JQ said...

I think it is Babesia. Small and extracellular rings are typical characteristics.

Old One said...

Lots of improvements in diagnostics since I've been around. I can only offer you "old school" blather.

The only time I"ve seen pirplasms that small were in lion's blood infected with what was thought to be Cytauxzoon (Theileria) sp.

The Merozoites appear to be too small for any of the human Plasmodiums except possibly P. falciparum. If I were to go out on a limb to guess I'd say Babesia (Theileria) sp. and if I were to hang by my toes to guess I would say B.(T.) microti or possibly B, divergens.

Anonymous said...

I'm torn on this one, the presence of the exracellular forms, and size of the nucleus, makes me think Babesia. However, I'm surprised not to see any tetrads in the images.

My vote is malaria

Colette said...

I'm with Blanie on Babes and Plasmodium. Do we have any more history on the patient to make a diagnostic differentiation??

Anonymous said...

T cruzi

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