- History A: A 26-year-old woman has had an irregular fever with chills, diaphoresis, myalgias, and fatigue for the past 2 weeks. On physical examination her vital signs include T 37.8 C, P 73/minute, RR 16/minute, and BP 110/70 mm Hg. She has mild hepatosplenomegaly but no lymphadenopathy. Laboratory studies show Hgb 12.3 g/dL, Hct 37.1%, MCV 96 fL, platelet count 217,800/microliter, and WBC count 7890/microliter. Her reticulocyte count is 3.2%. Her serum haptoglobin is 0.8 mg/dL.
Babesiosis: Match with Image 8.2 and Map Alpha (Massachusetts). The peripheral blood smear shows a characteristic tetrad of Babesia microti. The vector is the tick (Ixodes scapularis).
- History B: A 32-year-old man has been bothered by a fever for the past 3 weeks. On physical examination his vital signs include T 37.5 C, P 76/minute, RR 15/minute, and BP 125/80 mm Hg. He has an easily palpable spleen tip and mildly increased liver span. He has mild generalized lymphadenopathy. Laboratory studies show Hgb 11.7 g/dL, Hct 34.9%, MCV 83 fL, platelet count 139,200/microliter, and WBC count 2275/microliter.
Leishmaniasis: Match with Image 8.4 and Map Gamma (Spain). The bone marrow smear shows infiltration by leptomonads of Leishmania donovani infantum. The vector is the sand fly (Phlebotomus sp).
- History C: A 9-year-old girl has complained of a headache for the past 2 days. She then has the sudden onset of convulsions. On physical examination her vital signs include T 38.8 C, P 92/minute, RR 19/minute, and BP 85/50 mm Hg. Her spleen is palpable. She remains comatose. Laboratory studies show Hgb 5.1 g/dL, Hct 15%, MCV 100 fL, platelet count 82,000/microliter, and WBC count 9825/microliter. Her serum creatinine is 2.8 mg/dL, glucose 39 mg/dL, and total bilirubin 2.9 mg/dL.
Falciparum Malaria: Match with Image 8.3 and Map Beta (Sierra Leone). The peripheral blood smear shows many ring forms of Plasmodium falciparum. The vector is the mosquito (Anopheles sp)
- History D: A 12-year-old boy has not been eating well for the past week and has been listless. On physical examination vital signs include T 37.8 C, P 82/minute, RR 18/minute, and BP 90/55 mm Hg. He has periorbital edema and lower extremity edema. There is a morbilliform rash over his trunk. He has generalized lymphadenopathy. On auscultation of his chest lung fields are clear. He has an irregular heart rate.
Chagas Disease: Match with Image 8.1 and Map Delta (Brazil). The peripheral blood smear shows a trypomastigote of Trypanosoma cruzi. The vector is the Reduviid bug.
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