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Case #431 - November, 2016

A 62-year-old man from Kenya had been living in rural Connecticut with relatives for 6 months when he developed fever, chills, and fatigue. The family took him to their health care provider for medical attention. Blood work-up revealed anemia and blood smears were prepared, stained, and examined.  Figures A-I show what was found on thin smears.  What is your diagnosis?  Based on what criteria?

Figure A

Figure A

Figure B

Figure B

Figure C

Figure C

Figure D

Figure D

Figure E

Figure E

Figure F

Figure F

Figure G

Figure G

Figure H

Figure H

Figure I

Figure I

Figure J

Figure J

Case Answer

This was a case of babesiosis caused by Babesia sp. Morphologic features included:

  • pleomorphic and vacuolated intraerythrocytic ring-like parasites in normal-sized red blood cells.
  • extra-erythrocytic presentation of parasites (Figure I).
  • an absence of malarial pigment found in Plasmodium species.

Identification of Babesia to the species or strain level is not possible by morphology and requires molecular analysis of a blood specimen. Follow-up on this case included an EDTA blood specimen for PCR and the result was B. microti.

More on: Babesiosis

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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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.

  • Page last reviewed: December 9, 2016
  • Page last updated: December 20, 2016
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