An 84-year-old woman with fever and dark urine.

نویسندگان

  • Lauren G Gallagher
  • Sylvie Chau
  • Anjum S Owaisi
  • Mary Konczyk
  • Henry S Bishop
  • Paul M Arguin
  • Gordon M Trenholme
چکیده

Figure 1. Wright Giemsa-stained thin prep peripheral blood smears (original magnification, ϫ1000) demonstrating appliqué (B) and headphone (C) morphologies, which are characteristic of Plasmodium falciparum, and extracellular ring forms (D), which are characteristic of Babesia microti. Diagnosis: Babesiosis due to Babesia microti infection from a tick bite. Peripheral blood smear from the state laboratory showed intraerythrocytic ring forms as well as appliqué and headphone morphologies (figure 1B and 1C). Although some of the ring and appliqué forms were consistent with the morphological characteristics of Plasmodium falciparum, the patient had not traveled to an area where infection with P. falciparum was likely. Rare cases of Plasmodium vivax but not P. falciparum are reported in Quintana Roo, the state in Mexico where Cozumel is located. Although there have been recent outbreaks of P. falciparum infection in the Caribbean (i.e., Dominican Republic , the Bahamas, and Jamaica), Florida and the Cayman Islands are not areas in which malaria is endemic. In addition, B. microti infection was considered because of the travel history to an area where Babesia species are endemic (Minnesota) and because of a history of blood transfusions. Her blood smear showed many appliqué forms that are commonly seen in P. falciparum infection but are typically not characteristic of Babesia. Further examination of the blood smears at the US Centers for Disease Control and Prevention showed several extracellular ring forms that are more commonly observed with Babesia species infection (figure 1D). To determine conclusively the genus and species of the infecting organism, further diagnostic testing with polymerase chain reaction (PCR) was performed. PCR results were positive for B. microti infection and negative for all 4 Plasmodium species. There were 2 possible sources of the patient's babesiosis: tick-borne transmission or transfusion transmission. To evaluate the latter, all donors of blood products received by the patient were contacted and tested for B. microti antibodies. All donors were negative for such antibodies. Therefore, it is likely that the patient acquired babesiosis from a tick bite while visiting Min-nesota. The patient recalled no tick bite; however, recall of a tick bite does not always accompany tick-borne diseases [1, 2]. The typical incubation period for babesiosis after a tick bite is 1–6 weeks [3]. The number of cases of babesiosis reported annually in Min-nesota has increased in recent years. Eighteen cases were reported in 2006, compared with a median of 3 reports per year from 1992 through …

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

معرفی یک مورد نادر و آتیپیک واسکولیت کاوازاکی در بالغین

    Kawasaki is an acute multisystemic disease with high fever in infants. Kawasaki is an unknown vasculitis that involves small and moderate size arteries especially coronary vessels. Clinical manifestations of Kawasaki are nonspecific and consist of persistant fever for more than 5 days, maculopapular skin rash, mucosal inflamation, bilateral conjunctivitis, neck lymphadenopathy, erythema and...

متن کامل

Alkaptonuria in a middle-aged female

Background: Alkaptonuria (AKU) or ochronosis is a rare progressive degenerative arthropathy that results from deficiency of enzyme homogentisate 1,2 dioxygenase (HGD). The features include arthritis of the spine and in larger peripheral joints, with chondrocalcinosis. In this paper, we present a case of alkaptonuria in a 54 year old woman in Tehran, Iran. Case Presentation: A 54 year old woman ...

متن کامل

An Adult Woman Diagnosed with Recurrent Rheumatic Fever and Infective Endocarditis with Manifestations of Prolonged Fever and Heart Murmur

Background: Rheumatic Fever (RF) is a non-suppurative systemic inflammatory disease with a "delayed autoimmune" caused by Group A streptococcal infections. Inadequate RF treatment causes recurrent RF which is a predisposing factor for Infective Endocarditis. Case Presentation: A 39-year-old woman was admitted to the hospital with chief complaints of intermittent fever since one month ago, sh...

متن کامل

Gastrointestinal Tuberculosis with Cecum Involvement in a 33-Year-Old Woman

Abdominal tuberculosis is one of the most prevalent forms of extra-pulmonary tuberculosis. Various regions of gastrointestinal tract including cecum, terminal ileum, peritoneum, lymphatic system, and solid viscera can be affected by tuberculosis. Here we report a 33-year-old woman presented with fever, chills, and a history of abdominal discomfort. Lymphadenopathy was detected on physical exami...

متن کامل

Bacterial Infection in Infants and Children with Fever Selected for Lumbar Puncture

ABSTRACT Lumbar puncture (LP) is performed frequently in Pediatric departments to diagnose meningitis in infants and young children with fever. Children selected to have LP who do not have meningitis may, however, have other bacterial infections. During a 2-year desciptive study, we investigated lumbar punctures performed in pediatric departments of Bou-Ali, Emam-Hossein and Loghmane-Hakim ho...

متن کامل

Abdominal Compartment Syndrome after Cesarean Section: A Case Report

Background: Abdominal compartment syndrome (ACS) after cesarean section (CS) is a rare event which is associated with an increased risk of morbidity and mortality. This complication may arise as a result of musculoskeletal trauma and fluid accumulation. The present report aimed to introduce a case of ACS after the cesarean section. Case report: We present...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

دوره 49 2  شماره 

صفحات  -

تاریخ انتشار 2009