Case #424 – July 2016

A 22-month-old child presented to the emergency room after 10 days of cyclic fever and chills, decreased PO intake, and seizures. The child had emigrated from a country in the Middle East with her family three months prior. Blood specimens were collected for routine work-up. A CBC was flagged for low platelet count, and smears were made and stained with Wright-Giemsa. During microscopic examination of thin smears, a technologist identified possible malaria parasites. Images were captured and sent to the DPDx Team for diagnostic assistance. Figures A-F show six of the images received for consultation. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

Figure D

Figure E

Figure F

This was a case of malaria caused by Plasmodium vivax. Diagnostic morphologic features included:

sturdy rings with a large, single chromatin dot (Figures A and D).
large round gametocytes with fine pigment (Figure E).
schizonts with greater than 13 merozoites (Figures B-D); the object in Figure F shows a multiply-infected RBC that contains both a gametocyte and a schizont.

Figure A also showed bacterial contaminants. In addition to the morphologic features listed above, the patient’s travel history in a country in the Middle East was also supportive.

More on: Malaria

This case and images were kindly provided by Texas Children’s Hospital, Houston, TX.