Monthy Case Studies - 2003
Case #110 - June, 2003
A U.S. citizen traveled to the West Indies and stayed there for a month. About two weeks after returning from the region, the patient was seen by a physician for a high fever. The fever lasted for only a couple of days. Blood was collected, smears prepared, and stained with Giemsa. The objects in Figures A-D represent what was observed in very low numbers on the stained blood smear. What is your diagnosis? What kind of diagnostic tests would you recommend to confirm the microscopic examination?
Answer to Case #110
The objects seen in the images are artifacts. Sometimes stain debris or cellular debris can look similar to Plasmodium or Babesia parasites but key morphologic features of those parasites are lacking in these objects. Even if one object looks "suspicious," the diagnostic conclusion should be based on the sum of all objects observed. Further diagnostic testing such as serology or PCR analysis can be used to confirm or rule out malaria (or babesiosis, depending on travel history) in such situations. In this case, an EDTA blood specimen was requested and PCR performed for malaria. The results were negative for all four species of Plasmodium.
More on: Artifacts
Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.