Exflagellation of Plasmodium vivax and Dual Infection Diagnosed on Peripheral Blood Film: A Rare Case Report

Peripheral blood smear examinations are routinely performed as the first investigation to diagnose malaria. Various malarial forms such as Schizonts, ring forms (trophozoites), and gametocytes are seen in the patient's peripheral blood smears. Here, we report a sporadic case of a male patient in his early twenties who presented with dual infection with trophozoites and schizonts of Plasmodium vivax, trophozoites of Plasmodium falciparum, and multiple exflagellated microgametes of P. vivax in the peripheral blood smear examination. Identifying the exflagellated form of P. vivax is challenging due to its similarity with other hemoparasites. Exflagellation is very unusual during the developmental phase in the intermediate hosts such as humans, so exflagellated form should be reported correctly and promptly to receive appropriate treatment and prevent parasite transmission.