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Case study (3)- Malaria - Plasmodium ovale

Case study (3)- Malaria - Plasmodium ovale


An 18-year-old male student from Nigeria.

presented to the emergency room with symptoms of fever, shaking chills, nausea, and generalized malaise, occurring intermittently over the past five days.

Physical Examination:

Fever of 103.3°F.
Tachycardia with a heart rate of 122 b/m.
Otherwise within normal limits

Laboratory Investigations:

CBC (with microscopic differential)

RBC 5.85 x 1012/L

HGB 13.3 g/dL

HCT 41.8 %

MCV 71.5 fL

MCH 22.7 pg

MCHC 31.8 g/dL

RDW 12.1

WBC 6.2 x 109/L

N 89 %

L 8 %

M 2 %

E 1 %

B 0%

PLT 102 x 109/L

Results of the blood smear exam were:

RBC morphology: Normochromic. Numerous red cells contain intraerythrocytic organisms. Enlarged infected RBCs; some are oval-shaped, others appear somewhat "fimbriated." Doubly infected cells are present, and several morphologic stages can be found, including ring forms, mature schizonts, and gametocytes.

WBC morphology: Within normal limits

PLT morphology: normal

RBC enzyme: G6PD 11.7 U/g Hgb (RI 4.6-13.5)


Malaria - Plasmodium ovale

Upon further questioning, the patient stated that he had arrived in the United States from Nigeria approximately six months before this visit. soon after he came, he had experienced a similar illness that was diagnosed as malaria. The medication was prescribed, but once he felt better, he did not continue to take it.

according to the blood smear morphology, the periodic pattern of his fever and chills, and his travel history, the causative organism was identified as Plasmodium ovale.

Clinical Course

The patient was hydrated with normal saline and started on the appropriate treatment for the erythrocytic stages of malaria. Many days later he began a second course of therapy to eliminate the exoerythrocytic (hepatic) forms of the organism. He completed the course of therapy, and on subsequent visits was asymptomatic.

Note: Based on his low MCV, his relatively high RBC count, and his ethnic background, it is likely that this patient also has alpha thalassemia trait.