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Malaria due to Plasmodium falciparum and Plasmodium vivax infection Detection of female gametocytes of Pl. falciparum and Pl. vivax in blood films A 72 year old man presented at the Outpatient Clinic because of a fever of 39 °C of 10 days' duration. The patient also had suppurative inflammation in the right hand following a recent wound in this area. He was given ampicillin orally after which the hand improved significantly and the fever initially decreased. However, 3 days later the fever started again, with shivering and resistance to antipyretic medication, and the patient simultaneously developed jaundice with dark urine. Physical examination revealed mild painful splenomegaly and jaundice. The hematology findings were as follows: hematocrit 9.6%, WBC 12.000/μL (neutrophils 70%, lymphocytes 22%, eosinophils 5%, mononuclears 3%) and platelets 200.000/μL. The ESR was 96 mm/h, LDH 890 U/L, SGOT/SGPT 51/31 U/L, bilirubin 4.6 mg/dL (unconjugated 3.6 mg/dL), SAP 104 U/L, γGT 36 U/L. Serum electrophoresis revealed polyc;onal hypergammaglobilinemia. HIV antibodies and HbsAg were negative. The thick blood film revealed no parasites. The patient had not often taken his anti-malaria treatment and he had not been abroad for 6 months. As the jaundice and anemia were severe, the patient was admitted to the hospital. During hospitalization the leucocytosis and neutrophilia increased. The thin films (figures) showed no undistorted parasites in the red cells, but in spite of this, he was given anti-malaria treatment; 5 days later the fever vanished and his clinical status and laboratory findings became normal.
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