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Microbiology · Parasitology: Babesia
Sample itemA 62-year-old splenectomised man from the north-eastern United States has fever, haemolytic anaemia and haemoglobinuria after a summer hiking trip. The blood smear shows intraerythrocytic ring forms and tetrads (Maltese cross) without malarial pigment. What is the likely organism?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Babesia microti
Babesia microti is transmitted by Ixodes ticks and infects red cells, causing a malaria-like illness that is severe in asplenic, elderly or immunosuppressed patients. Smears show rings and tetrads but no haemozoin pigment or gametocytes. Treatment is atovaquone with azithromycin, and severe cases may need exchange transfusion.
Option by option
A. Anaplasma phagocytophilum
Anaplasma forms morulae within neutrophils, not within red cells.
B. Plasmodium falciparum
P. falciparum forms crescent gametocytes and pigment and is not tick-borne.
C. Babesia microti (correct)
Tetrads in red cells without pigment are characteristic of Babesia.
D. Ehrlichia chaffeensis
Ehrlichia forms morulae within monocytes, not within red cells.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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