Case #277 – June, 2010

A 29-year-old female went to her health care provider with complaints of fever and headache, two weeks after returning home from trips to Uganda and Sudan. She admitted that she only took malaria prophylaxis whenever she did not feel well. A blood smear was ordered by her physician. Figures A–F show what was observed on a Giemsa-stained thin blood smear. 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 malariae. Diagnostic morphologic features shown included:

smaller than normal infected red blood cells.
parasites with coarse pigment.
basket-form (Figures A and B) and band-form (Figure C) trophozoites.
a schizont with fewer than 12 merozoites (Figure F).