Peripheral Microscopic Localization of Plasmodium falciparum Garnham Body in an Immature Stage-III Gametocyte in Fatal Cerebral Malaria

Immature gametocytes of Plasmodium falciparum ( P. falciparum ) are localized in the bone marrow and spleen for their development. Upon maturation, these immature gametocytes release to the peripheral circulation for sporogony and subsequent reproductive phases which leads to malaria transmission. Garnham (G) bodies are curious structures seen rarely inside immature gametocytes and never reported in malarial literature after their first identification by Garnham in 1933 from Kenya in a fatal malaria case. Here, a case of fatal malaria from India is reported for the first time, with the demonstration of peripheral microscopic localization of P. falciparum G body present inside an immature gametocyte. A 23-year-old male patient died of cerebral malaria and multi-organ dysfunction within 19 h of hospitalization to a tertiary care hospital. Examination of his peripheral blood on admission using Giemsa-stained light microscopy followed by differential interference contrast imaging in a confocal microscope revealed presence of a G body inside an immature, stage-III gametocyte of P. falciparum . The patient was diagnosed to have cerebral malaria along with jaundice and acute renal failure, and had received antimalarial artesunate along with other therapies and intensive care. Microscopic localization of P. falciparum G body inside immature gametocyte (stage-III) especially in peripheral human circulation, is an extremely rare observation in clinical malaria, only second to Garnham’s discovery since 1933. It portrays a peculiar phenomenon in the malaria parasite’s life cycle that may derive newer avenues for exploring the genetics underlying the “trade-offs” of immature and mature gametocytes, prospects for transmission-blocking drug discovery and vaccine design strategies. Clin Infect Immun. 2019;4(2):27-30 doi: https://doi.org/10.14740/cii62w