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Case Study 2, Question 1: Correct Answer

Plasmodium malariae : The most likely diagnosis, based on microscopy and clinical history. Note the typical microscopic characteristics: all stages of parasites present; band - form trophozoite (image 1); round, rosette-shaped schizont (image 2); and round gametocyte (image 3, at right). The microscopic diagnosis of P. malariae was confirmed by PCR. The parasitemia is 1.8%, which is high for P. malariae (note that in image 3, four parasites are crowded in a relatively small field). The mild or absent symptoms of malaria in the mother is compatible with P. malariae, a parasite that can persist for years, even a lifetime, with minimal symptoms . Plasmodium malariae is known to occur in DR Congo, where it is second in prevalence (by far) to P. falciparum .