Hiperparasitemia por Plasmodium falciparum como criterio diagnóstico de malaria grave. Fotografía médica.

Paciente masculino de 37 anos de edad, procedente de Santa Lucia, estado Miranda, quien refiere fiebre diaria no cuantificada de una semana de duracion precedida de escalofrios y sucedida por diaforesis; concomitantemente cefalea, artralgias y lumbalgia. El paciente niega episodios malaricos anteriores. Es hospitalizado, encontrandose palidez cutanea, tos seca y hepatoesplenomegalia al examen fisico. Se toma muestra de sangre periferica para realizar gota gruesa y extendido con coloracion de Giemsa invertido y se observa a microscopia optica (aumento de 1,000X, Nikon Eclipse E200®). Notese la gran cantidad de trofozoitos anulares en la gota gruesa, mientras que en el extendido se observa un gametocito, varias formas applique y eritrocitos con poliparasitismo. Se evidencia aproximadamente un 20% de eritrocitos parasitados, con una parasitemia estimada de 98.850 parasitos/μL. Plasmodium falciparum es el agente etiologico mas frecuentemente asociado a malaria grave, dentro de cuyos criterios diagnosticos destacan: hiperparasitemia, distress respiratorio, malaria cerebral, hipoglicemia, insuficiencia renal, entre otros [1]. La hiperparasitemia es uno de los criterios de laboratorio para severidad; una parasitemia >10%, incluso en ausencia de hallazgos clinicos de severidad, indica malaria grave [2,3]. Medical Photograph: hyperparasitemia by Plasmodium falciparum as a diagnostic criterion of severe malaria A 37 year-old male from Santa Lucia, Miranda state, complained of unquantified daily fevers for the past week, preceded by chills and followed by profuse sweating; also, he complained of headaches, as well as pain in his joints and lower back. The patient denied any previous episodes of malaria. Physical examination during hospitalization showed pallor, dry cough and hepatosplenomegaly. A peripheral blood sample was taken for thick and thin smears with an inverted Giemsa’s stain and later observed under optical microscopy (1,000X magnification, Nikon Eclipse E200®). Note the large amount of ring-form trophozoites in the thick smear, while the thin smear shows a single gametocyte, many applique forms and red blood cells with polyparasitism. There are approximately 20% of infected red blood cells, with an estimated parasitemia of 98,850 parasites/μL. Plasmodium falciparum is the species most frequently associated to severe malaria, which includes the following as its most distinguished diagnostic criteria: hyperparasitemia, respiratory distress, cerebral malaria, hypoglycemia, kidney failure, among others [1]. Hyperparasitemia is one of the laboratory criteria for determining