At a lab I previously worked at (independent lab, not hospital based)
all malaria smears were given to pathologists for final diagnosis. I'm
not sure how they signed them out. The only ones I ever heard about
there were CAP surveys or negative patients.

We recently had a positive on an 8 year old child that had been in
Kenya. Even though the smears are routed through hematology instead of
microbiology, our department gets in on it anyway. Luckily, one of our
techs worked for two years at Cleveland Clinic doing parasitology
exclusively all that time. She looked at the smears and determined that
it was indeed P. falciparum (in about 5 minutes). Our Ph.D.
microbiologist came in (second shift) to confirm it. We knew the patient
was being transferred to us from an outlying rural hospital as the ID
doc gave us a 4 hour heads-up. He requested that we speciate, if
possible, that evening. He must have been suspicious that it was P.
falciparum, possibly from severity of symptoms, although I never did
hear how the case came out.

I think that a lot of experience is the essential key to speciation. CC
obviously got patients from all over the world, and the experience she
gained there was the key to the quick diagnosis.

As far as your original question as to the speciation of non-falciparum,
I really can't say. We just don't get enough of them to comment. I've
only been at my current employer for 3 years and this was the first
positive we've had, I guess, in at least a decade or longer.

What do your pathologists say?

Judy Dilworth, M.T. (ASCP)
Microbiology

We speciate ours in hematology and all slides are submitted for review at
the county public health lab and again confirmed ID at the state public
health lab.  Obviously from an epidemiology point of view it is important.
Ovale is very limited in geography to Africa so it is very rare.  Vivax is
dependent on Duffy blood group and here in America the black ethnicity
parallels the African genetics where 80% are Duffy negative so most are
immune to Vivax.
Many ring forms and little else in a Black is most likely Falciparum.
Many variable intermediate forms in a Caucasian is vivax or malariae with
the dots being important etc.
We have seen mixed in the past with Vivax and falciparum where bananas were
seen and intermediate forms of vivax were present so one must always look a
long look at a slide to avoid a big mistake in seeing the obvious and
calling it non-falciparum.