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Case of the Week 40

The following peripheral blood film was obtained from a patient living in Missouri. Besides being an outdoorsman, he had traveled extensively in the past year, and visited many parts of Africa and Asia.

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My initial differential would be Babesia vs Plasmodium falciparum with the high parasite load. There are numerous intracellular ring forms. I would lean toward Babesia with several ring forms in single erythrocytes, but I don’t know how I’d rule out falciparum malaria from these smears…

it looks like babesia. in order to differentiate fron falciparum, one has to look for extraerythrocytic gametocytes, which r present in falciparum malaria but extraerythrocytic forma r absent in babesiosis.