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        DPDx - Laboratory Identification of Parasites of Public Health Concern
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        Case #266 – December, 2009
          Case #266 – December, 2009
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                A 40-year-old man sought medical attention at a hospital one week after returning from a mining operation in Ghana. He presented with diarrhea, vomiting, and night fevers. Although not confirmed, it was assumed that he did not take any anti-malarial prophylaxis. Two sets of thick and thin blood smears were made, one set of which was stained with Wright-Giemsa. Both the stained and unstained smears were sent to the CDC for diagnostic assistance. Figures A–E show what was observed on the pre-stained thin smear in moderate numbers. What is your diagnosis? Based on what criteria?
                    Figure A
                    Figure B
                    Figure C
                    Figure D
                    Figure E
                    Figure F
                  Case Answer
                        This case was a mixed infection of malaria, caused by Plasmodium falciparum and P. ovale. Diagnostic features included:
                          * thin, delicate ring forms in normal-sized RBCs, consistent with P. falciparum (all Figures).
                          * appliqué (accolade) forms consistent with, though not exclusive to, P. falciparum (Figures A, B, D, E and F).
                          * enlarged, oval-shaped, and fimbriated infected RBCs with a large gametocyte (Figure C) and large and somewhat amoeboid trophozoites (Figures B and F), consistent with P. ovale.
                        The unstained thin smear submitted to CDC was subsequently stained with Giemsa. Figures G–J show that Schüffner’s stippling was observed in some of the infected RBCs, supporting the diagnosis of P. ovale. Schüffner’s stippling was not observed in any of the RBCs exhibiting P. falciparum rings. This case highlights the importance of using Giemsa stain, at a pH at or near 7.2, over Wright-Giemsa stain, in helping to assure an accurate diagnosis is made. EDTA blood was also received for this case, and PCR performed on the blood confirmed the mixed infection.
                        Figure G
                        Figure H
                        Figure I
                        Figure J
                        More on: Malaria
                Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
      DPDx is an educational resource designed for health professionals and laboratory scientists. For an overview including prevention, control, and treatment visit www.cdc.gov/parasites/.
      Last Reviewed: August 24, 2016
        Source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Parasitic Diseases and Malaria
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              o Staining
              o Microscopic examination
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              o Extraction of DNA from blood specimens
              o Detection of parasite antigens
              o Isolation of organisms
              o Special tests
              o Inactivation of Ebola/Marburg for malaria testing
          + Stool Specimens plus icon
              o Safety
              o Specimen Collection
              o Specimen Processing
              o Shipment
              o Staining
              o Microscopic examination
              o Detection of parasite antigens
              o Molecular diagnosis
              o Extraction of Parasite DNA from Fecal Specimens
              o Morphologic comparison of intestinal parasites
          + Serum/Plasma Specimens plus icon
              o Safety
              o Specimen Requirements
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              o Tissue specimens for free-living amebae(FLA)
              o Isolation of Leishmania organisms
              o Sputum
              o Aspirates
              o Sputum, induced sputum, and bronchoalveolar avage (BAL)
              o Vaginal swabs for diagnosis
              o Procedure for demonstration of pinworm eggs
              o Urine
              o Whole Organisms
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