Diagnosis? Where did he likely acquire this infection?
Monday, May 25, 2020
Case of the Week 592
This week's interesting case was donated by Drs. Lee Decollings and Dejan Nikolic. The patient is a middle-aged male with travel approximately 2 months ago to Ethiopia, Nigeria and Cameroon. In the past few years, he has also traveled broadly in sub-Saharan Africa, Asia and South America. He presented with fever and myalgias following a recent medical procedure.
Diagnosis? Where did he likely acquire this infection?
Diagnosis? Where did he likely acquire this infection?
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16 comments:
For sure a beautiful case of malaria. The infected red cells are not enlarged and therefore no predilection for reticulocytes, ruling out both P. vivax and P. ovale. Thé presence of mature trophozoites and a schizont in picture one combined with the absence of ring forms help us eliminate P. falciparum. The only band form help narrowing our choice to P. malariae. There does not appear to be any primate involvement nor arboreal canopy activity, so a diagnosis of P. knowlesi is unlikely.
Florida Fan
Plasmodium malariae. trofozoiti a banda equatoriale
Travel history was endemic of this parasite
Normal-sized rbc
Band form gametocytes
Rosette schizonts
It must be Plasmodium malariae
WKML
Excellent photomicrographs, most likely of P. malariae. Given the patient's extensive travel history, and with no other information, it is difficult to pinpoint the location of acquisition.
The band form conjures up in my memory: P. malariae.
BW in Vt
Elegantly presented and answered. many thanks for the multiple lessons. cheers! ~ smith
P. malariae, bandform, gametocytes, schizonts. These three African countries seem to have P. malariae although less frequently than other species.
Malariae
Fist beautiful pictures. Small parasited RBC, band and basket forms, few nuclei in schizont are consistent with P.malariae
That's a nice description.
Agree 100 percent.
Nice photographs!
I agree: small size of infected RBCs, band forms, schizonts with few merozoites,... all point in the direction of P. malariae.
Place of acquisition can be more or less anywhere, as P. malariae can remain sub-clinically present for many years.
Although Asia is in the travel history, I would consider P. knowlesi very unlikely, as this species would be very virulent and unlikely to remain two years subclinical.
I am curious about the medical procedure ...
Did he have an organ transplant?
Great question about the procedure Idzi. It was nothing that resulted in immunosuppression. He is immunocompetent as far as we know.
Okay! Thanks for the quick reply Dr. Pritt!
Textbook P. malariae, acquired on Africa. Although Asia is in the travel history, but probably too long ago to be P. knowlesi (besides, the form of the merozoites in the schizont do not support a morphologic identification of P.k.)
Plasmodium malariae that read the textbook. Very nice baskets, bands, and perfect number of merozoites in the schizont.
“Hello” to Dr. Nikolić!
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