Case #485 - February, 2019

A 62-year-old man returned from visiting family in Cambodia with fever and chills. Thick and thin blood smears stained with Giemsa were prepared and examined at 1000x magnification with oil. Figures AF show what the technician observed and sent to the DPDx Team for identification. What is your diagnosis? Based on what criteria?

This case was kindly provided by the Missouri State Public Health Laboratory.

Parasitic image

Figure A

Parasitic image

Figure D

Parasitic image

Figure B

Parasitic image

Figure E

Parasitic image

Figure C

Parasitic image

Figure F

This was a case of malaria caused by Plasmodium malariae. Morphologic features shown include:

  • Characteristic band form trophozoite with coarse pigment. (Figure B).
  • Infected red blood cells (RBCs), normal to 0.75x in size (Figures AF).
  • Ring stage parasites with delicate cytoplasm and prominent chromatin dot – not exclusive to P malariae (Figures A and F).
  • Mature schizont with 8-12 merozoites and coarse, dark brown pigment (Figure C).
  • Gametocytes in normal to 0.75x size RBCs (Figure E).

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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.

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Page last reviewed: April 18, 2019