An 11-year-old girl presents to a pediatrician’s office in New Jersey in late summer with a history of seven days of fever, reaching a maximum of 40.6 degrees Celsius (105 degrees Fahrenheit). She describes fatigue associated with chills, sweats, mild arthralgia, abdominal pain and a nonproductive cough.

Significant findings on physical examination are a palpable spleen and conjunctival injection. Her blood work reveals hemoglobin 8.7 g/dL (normal 10.7 to 12.7 g/dL), hematocrit 25.6% (normal 32% to 37.1%), white blood cell count 10,300 cells/μL and a C-reactive protein 216 mg/L (normal 0-7.5 mg/L).

A picture of a Giemsa stained peripheral blood smear is shown.

The most likely diagnosis is:

A Giemsa stained peripheral blood smear from a young child who had undergone splenectomy for spherocytosis. The tetrad of merozoites seen in the erythrocyte in picture A is referred to as a Maltese cross, although it is seldom seen.

Answer: c.) babesiosis...

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