Malaria Case Presentations

Here we present some photomicrographs taken from real case presentations.

Case One

This is a thin film from a 27 year old female backpacker, with a recent history of trekking through Northern Thailand and high fever.

Salient features are:

• Numerous fine ring forms.
• Double chromatin dots.
• Marginal forms.
• Red cells are not enlarged.

This is a typical Plasmodium falciparum presentation.

Case Two

A thin film from a 22 year old male holidaying in Lombok (Indonesia) one month previously.  Intermittent fevers since returning.

Salient features are:

• Developing and thick (signet) ring forms.
• Enlarged red cells.

This is a typical Plasmodium vivax presentation.

Case Three

Recent travel in Africa.  Pyrexia of unknown origin.

Salient features are:

• Developing form of plasmodium.
• "Comet-like&wquot; red cells.
• Enlarged red cell.

This is a typical Plasmodium ovale presentation.

Case Four

Female patient, arrived from Brazil two weeks previously.  Flu like symptoms since arrival.

Salient features are:

• Broad band form of plasmodium.
• Red cells not enlarged.

This is a typical Plasmodium malariae presentation.

Case Five

This is a thick film prepared from a 32 year old male recently returned from Vietnam.

Salient features are:

• Numerous ring form of Plasmodium can be seen (as indicated by the arrows).
• Note size of neutrophils (for comparison).

The only definitive diagnosis that can be made from this film is that Malaria is present.  Thin films would have to be examined for species identification.

Case Six

This is a thick film prepared from a recent arrival from India who presented with a high temperature.

Salient features are:

• No parasites seen in this field

This film would need to be examined for 10 minutes before being called negative.  Repeat films should be prepared and examined on at least 2 further occasions, ideally as the temperature peaks, before the presence of Malaria can be excluded.

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