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Monthy Case Studies - 2003
Case #115 - September, 2003
A female patient who received kidney and pancreas transplants from a cadaveric donor returned to the hospital with febrile illness six and a half weeks after the surgery. Recent travel outside of the US was not reported. A peripheral blood smear was prepared, stained with Giemsa, and examined. The organism in Figure A was observed on the smear. What is your diagnosis? Based on what criteria?
Figure A
Answer to Case #115
This was a case of Chagas Disease (American trypanosomiasis) caused by an infection with Trypanosoma cruzi and was acquired due to organ transplantation. Diagnostic features observed included:
- a trypomastigote of T. cruzi with an undulating membrane.
- the presence of a prominent, posteriorly-located oval kinetoplast (blue arrow) and a nucleus, usually situated in the center of the body (red arrow).
- the size of the organism, which was in the size range for T. cruzi (approximately 20 micrometers, range 12-30 micrometers).
It should be noted that Trypanosoma rangeli can also infect humans in the Americas, overlapping the geographic distribution of T. cruzi infections. However T. rangeli has a smaller kinetoplast and is usually longer and more slender (average length of 30 micrometers) than T. cruzi. There is no pathology associated with T. rangeli infections in humans.
Figure A
More on: Chagas Disease After Organ Transplantation --- United States, 2001 (MMWR)
Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
