#00065165

59-year-old male presented to the emergency department with pyrexia, worsening back pain and nausea.  Recent travel history included visits to Mumbai, Goa, and Spain in the previous year with a significant asymptomatic period.  FBC performed demonstrated mild thrombocytopenia (130 x 10^9/L) with no anaemia.  Blood film morphology showed multiple stages of P. vivax infection with amoeboid ring forms/mature trophozoites and gametocytes (the image shows mostly gametocytes and mature trophozoites).  The patient was treated successfully with artemether-lumefantrine and primaquine.  Confirmation of species was provided by the UK Malaria Reference Laboratory.  Due to the travel history, this case raises the possibility of a long latency Plasmodium Vivax malaria infection. 

Long latency Plasmodium Vivax is a rare infection not generally seen in the modern diagnostic laboratory.  It typically has an 8-10 month latency period between primary infection and relapse which would align with this case.   

Consequently this case was targeted for sequencing by the Centre for Tropical Medicine and Global Health,  University of Oxford.