How is babesiosis distinguished from Plasmodium?

Updated: Apr 01, 2021
  • Author: Rachel E Strength, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Babesia may be mistaken for malarial parasites, particularly the ring forms of P. falciparum. [11]  Helpful features that distinguish Babesia from Plasmodium include the following:

·       Absence of brownish pigment deposits (hemozoin)

·       Lack of synchronous stages (schizonts and gametocytes observed with Plasmodium species)

·       Occasional presence of tetrads 

In addition, Babesia varies more in shape and size and may be observed outside erythrocytes in patients with higher levels of parasitemia.

Thick smears can sometimes increase sensitivity due to the increased number of erythrocytes seen on a thick smear; however, Babesia may be easier to detect on thin smears due to the size of the organisms.  It is important to have personnel who are experienced in preparation and review of these smears. [3]

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