A 17 year old male presents to the ED with a headache. The patient states that he returned from US. he felt well when he initially arrived from, but developed a severe headache soon after. The headache is constant and throbbing, lasts throughout the day, and is relieved with ibuprofen. He is experiencing subjective fevers and intermittent sweats, worsening headache, bilious emesis, palpitations. The patient denies having any trauma, seizures, abdominal pain, stiff neck, or photophobia. Examination of the abdomen reveals normal bowel sounds, with mild tenderness to palpation in the right and left upper quadrants. Investigations include: Creatinine: 1.2 mg/dL; Magnesium: 1.2 mg/dL; Total bilirubin: 2.7 mg/dL; Direct bilirubin: 0.9 mg/dL; and Alkaline phosphatase, 152 U/L. A complete blood count reveals a white blood cell count of 5.7 × 103 cells/µL, a hematocrit of 44% , and platelet count of 34 × 103 cells/µL. A blood smear is obtained: Diagnose the case and suggest further management.

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Dx :- Babesosis due to Babesia sp Smear shows both intra and extra cellular (at 9 'O clock position ) . Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a genus of Apicomplexa. It's difficult to comment on species. Babesia microti—which usually infects white-footed mice and other small mammals—is the main species that has been found in people in the United States( which is spread by Ixodes scapularis ticks, which are commonly called blacklegged ticks or deer ticks.). Occasional cases caused by other Babesia species have been detected. **The parasite typically is spread by the YOUNG NYMPH STAGE of the tick. Rx :- It is usually sensitive to Quinine, Clindamycin and Azithromycin. Two regimen is usually recommended. 1 ) IV Clindamycin and oral Quinine or 2 ) IV Atovaquone and IV Azithromycin to avoid acute renal failure. Combination therapy with clindamycin and Quinine or Atovaquone and Azithromycin is more effective than either Atovaquone or Azithromycin alone. Do not give Quinine to pregnant patients. Sometimes intubation and mechanical ventilation may be required for patients who develop respiratory distress or failure.

thanks doc. Indeed informative for me
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The overall clinical presentation - flu like symptoms - Fever , headaches , sweats , tender hepatomegaly with hepatic dysfunction along with Peripheral smear Findings - Erythrocytes with multiple trophozoite and rings ( heavily parasitised rbcs ) along with Thrombocytopenia and an occasional polychromatophil also seen ( haemolysis)are pointing towards a diagnosis of Plasmodium Falciparum Infection

Babesiosis.. Babesia canis.. Observed on Giemsa stain.. parasites observed within Erythrocytes. Classical presentation of Fever Thrombocytopenia Headache n Altered LFT.. plus visit of USA.. so clinically also babesiosis suspected. Treatment includes.. 2 regimes.. 1) Atovaquone + Azithromycin 2)Quinine + Clindamycin.

Incubation period is 1 to 3 weeks.. which again fits in this case.
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@Dr. Hemant Adhikari Ji,its migraine,Apanvayu prakop,abnormal mall, mutts,(kosthbadda) Tab.Arogyvardhani 2 bd, Tab. Sutsekhar Ra's 2 bd, Tab. Gadharb haritagi 2 bd, with warm water,Tab.shirsuladi bajrang 1 bd, Tab.Brahmnibati 1 bd, Its OK.

trophozoites seen in RBCs...could be malaria or babesiosis...do the card test to rule out malaria....as visit to US strongly suggests Babesia

p.flciparum.only. babesis in in four ring tetrad form.so it is rue out.

Plasmodium falciferum Give premaquin FALCIGO KIT

Along with inj FALCIGO 120 mg Iv stat then 60 mg Iv bid for 5 days
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Plasmodium falciparum ...acole forms r seen.

?? Malaria Anti malarial tab

Thanks Dr.Moti Wadhawani, It's maybe.
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Cerebral malaria.signet ring rbc points towards p.vivax. start him with quinine mean while rule out other hemoparasites infection

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