Background: Presence of Plasmodium falciparum’s schizontes in peripheral blood is usually associated with severe malaria. However, presence of schizontes and pigment containing leucocytes is usually not recorded on the laboratory reports in clinical settings and yet theses stages findings may be helpful to manage the patient in context of low transmission of malaria. An uncomplicated form of falciparum malaria contrasting with high schizontaemia, in a child living urban area of Dakar is discussed.
Case presentation: A six-year-old boy presented to the health clinic of Pikine (Dakar) with fever, headache and abdominal pain. There was neither vomiting nor diarrhea. All physical examination was normal. HRP2 based rapid diagnostic test was intensively positive. Blood smear showed malaria parasites identified as Plasmodium falciparum with 3.6% parasitaemia. There was also high proportion of schizontaemia (0.4%) and malaria pigment-containing neutrophils and monocytes. Merozoite cluster and haemozoin pigment were observed into a monocyte, as a phagocytosis outcome.
There was no anaemia and all others laboratory tests were normal. Treatment consisted of classical artemisininbased combination treatment. Recovery was noted at day 3, confirmed by negative microcopy. No further symptoms were noted.
Conclusion: Schizontes of Plasmodium falciparum usually sequester in microvascular so these stage is not seen in peripheral blood. In low transmission areas or in non-immune person the presence of schizontes in the peripheral circulation is associated with worse prognosis. This case, unexpected in view of the relatively moderate symptoms of the disease, was likely to be expression of good immune response against the blood stages of P. falciparum. Patients with a high parasite count (>4%) or presence of schizontaemia in a low transmission area but none of the clinical or laboratory indicators of severe malaria should be monitored closely.