Monthly Case Studies - 2005
A lab worker discovered an unlabeled box of 20 pathology slides, which appeared to be stained with hematoxylin and eosin (H & E). The slides were examined to determine what was on them. Figure A shows what was seen on one of the slides at 200× magnification. What is your identification? Based on what criteria?
A 28-year-old man complained of gastrointestinal pain and bloating. At the request of his health care provider, he submitted a fecal specimen preserved in low viscosity polyvinyl alcohol (LV-PVA). A trichrome stained smear was made from some of the specimen. Figure A shows an object, measuring 10 to 12 micrometers at its greatest diameter, that was seen in low numbers on the slide. What is your diagnosis? Based on what criteria?
In April 2005, DPDx telediagnosis inquiries received a request for assistance from the Oregon State Public Health Laboratory. Images from a thick and thin blood smear were submitted. Based on information that came with the specimen, the smears were most likely stained with Giemsa. The only case history available was that the patient lived in Africa until the beginning of this year. Figures A-C show what was observed on the thick smear. Figure C is a close-up of the posterior end of the object in Figure B. Figures D-F show what was observed on the thin smear. In Figure D, the object measured 300 micrometers; close-ups of the posterior and anterior ends are shown in Figures E and F, respectively. What is your diagnosis? Based on what criteria?
A 45-year-old woman went to her physician with complaints of recurring abdominal cramping, bloating, and infrequent diarrhea. Her travel history included a 10-day camping trip in Alaska, and her symptoms had started approximately 2 weeks after her return. Her physician ordered an ova and parasites (O & P) examination. Figures A-D show objects observed on a trichrome stained fecal smear; A-C were found in moderate numbers on the smear, while D was found in very few numbers. The objects shown ranged in size from 5 to 7 micrometers. What is your diagnosis? Based on what criteria?
A 13-year-old boy was seen by his pediatrician for watery diarrhea, abdominal cramping, and low-grade fever that had persisted for 3 days. His symptoms began approximately 5 days after returning from a summer camp trip to a petting zoo. The physician ordered an ova and parasites (O & P) exam. The lab personnel followed their typical O & P procedure by performing an FEA concentration from formalin preserved stool and making wet mounts, and using PVA preserved stool to make trichrome stained smears. Figures A and B show objects seen in low numbers on a wet mount (A) and the trichrome stained smear (B). The round objects measured an average of 5 micrometers in diameter. The laboratory reported a presumed diagnosis of parasitic protozoa. What organism do you suspect? Based on what criteria? What, if anything, else needs to be done?
A woman went to a local emergency room due to fevers and chills. She reported that she had traveled abroad to Burma and Thailand recently for three weeks. When she traveled abroad previously, she had taken malaria prophylaxis that she received from a travel clinic, but she had not returned to the clinic before her most recent trip. A blood film examination was ordered, and thick and thin smears were made and stained using ENG Scientific Malarial Quick Stain. The hospital sent the smears to the Rhode Island Department of Health Laboratory for identification of species. The RI laboratory sent images captured from the smears to the DPDx telediagnosis assistance for confirmation. Figures A-D were captured at 1000× magnification. What is your diagnosis? Based on what criteria?
A 42-year-old animal trapper sought medical attention regarding an ulcerative lesion on his arm (Figure A). He reported that he had been in Bolivia two months ago and that the lesion on his arm had grown worse since his return. A biopsy of the lesion on his arm was performed and a touch prep smear prepared and stained with Giemsa. The tissue was sent to pathology to be sectioned and stained with H & E. Figures B and C show objects observed on the Giemsa stained touch prep smears, and Figures D and E show objects observed on one of the H & E slides. What is your diagnosis? Based on what criteria?
A 45-year-old man was admitted to a local emergency room in a comatose state after apparently having a heart attack. The man never regained consciousness and expired the next day. His patient history, gathered from his wife, included high blood pressure and high cholesterol levels as well as complaints of abdominal pain, intermittent diarrhea, noticeable weight loss, frequent headaches, and occasional shortness of breath for the past 5 months. His wife stated that he had been working abroad for one year in the Philippines and had just returned home for a one-week visit. An autopsy was performed to determine the cause of death. Figure A shows an image captured from a hematoxylin and eosin (H & E) stained slide of a section of intestinal tissue. Although not the cause of the man's death, what is your diagnosis of this incidental finding? Based on what criteria?
A 6-year-old girl complained to her parents that her head was itchy after returning from a 4-week summer camp in the southeastern United States. Her parents took her to the doctor where she was examined. The doctor observed small, whitish objects located near the base of hair shafts on the scalp. Although the physician was able to make a diagnosis based on what he observed on the patient's scalp, he did collect a few hairs to examine under the microscope. Figure A shows the objects that were found on the girl's head and Figure B shows a close up of the objects that were found on the girl's hair shafts. What is your diagnosis? Based on what criteria?
A 50-year-old returned to the United States after working with a missionary group in Mali and Senegal for 10 years. He went to a local hospital with a low-grade fever for 2 days. The physician ordered a blood film examination and thick and thin films were made and stained with Giemsa. Figures A-D show the objects, ranging in size from 236 to 245 micrometers, that were seen on the thick blood film. Figures A and C were captured at 400× magnification and Figures B and D were captured at 1000× magnification. What is your diagnosis? Based on what criteria?
A 61-year-old New England resident was visiting his relatives in Georgia for the summer. He had recurring fevers and general weakness and at night he often experienced gastrointestinal discomfort. His relatives took him to a local hospital where he was examined and both blood and stool were collected for testing. An ova and parasite (O & P) examination was ordered for the stool specimen, and blood smears were made from the blood specimen and stained with Wrights-Giemsa. The O & P was negative for parasites. Figure A is taken from an area of the stained thick blood smear, and Figures B-D were from the thin smear. What is your diagnosis? Based on what criteria?
A 25-year-old woman had a few mildly scaly lesions on her forehead. She saw her physician and initially it was thought that she had a fungal lesion. Figure A-C show what was seen in skin scrapings from the lesion. The object shown was approximately .25mm long. What is your diagnosis? Based on what criteria?
A 42-year-old man complained of diarrhea for 2 weeks following an international assignment that included travel to countries in Southeast Asia and the Indian subcontinent. He explained to his physician that his symptoms began shortly before he returned to the United States. An ova and parasites (O & P) examination was ordered, and Figures A-D show what was observed. Figures A and B are from a wet mount stained with Lugol's iodine, and Figures C and D are from a trichrome stained fecal smear. The objects ranged in size from 20-25 micrometers. What is your diagnosis? Based on what criteria?
A 25-year-old woman with symptoms of intermittent fever, nausea, and headaches went to the emergency room with a temperature of 104º. She had worked and traveled in West Africa for the previous five months. Although she had taken antimalarial drugs while she was abroad, she ceased prophylaxis when she returned to the United States. While at the emergency room, the attending physician ordered a blood smear, which was stained with Wright-Giemsa and examined. Figures A-F show what was observed on the thin smear at 1000× magnification. What is your diagnosis? Based on what criteria?
A 25-year-old man living in South America became ill with intestinal cramping and watery diarrhea. Stool specimens were collected and an O & P exam was ordered by his physician. The lab performed an FEA concentration on the sample, prepared wet mounts, and examined them using UV fluorescence microscopy. Images were captured and submitted to DPDx/CDC. Figures A and B were taken at 400× magnification. What is your diagnosis? Based on what criteria?
An 8-year-old boy complained of bloating and intermittent diarrhea, and he told his mother he had passed a worm when he went to the bathroom. They went to a physician and reported that the boy had a history of chronic stomach problems and gastrointestinal reflux. No travel history or date of symptom onset was given. The physician ordered an ova and parasite (O & P) examination. A stool specimen was collected at a local medical facility and submitted for testing. Figures A and B show objects that were seen on a wet mount smear, at 100× and 200× magnification respectively, from an FEA concentration performed at the California State Department of Health Services laboratory. What is your diagnosis? Based on what criteria?
A 49-year-old male immigrant from Mexico was seen at a local medical facility specializing in neural disorders for frequent headaches and occasional seizures. Figures A and B show what was observed on a hematoxylin and eosin (H & E) stained section of lesions detected in the right frontal lobe of his brain. Figure A was taken at 40× magnification and Figure B was taken at 100× magnification. What is your diagnosis? Based on what criteria?
A 32-year-old male from Nigeria had been visiting some relatives in the United States for approximately a week. He went to a local emergency room for headaches, nausea, and general weakness and fatigue. Blood was drawn by fingerstick and thick and thin blood films were made. Images from the thick smears were captured and sent to CDC for confirmation. Figures A and B show what was seen on the Giemsa stained thick film when it was examined. What is your diagnosis? Based on what criteria? What additional steps would you recommend to achieve a definitive diagnosis?
A 25-year-old male went to a local hospital complaining of a two-week history of worsening irritation of his left eye. He resides in a semi-rural area, where sheep and horses are raised, and recently returned from Samoa four weeks previous to his hospital visit. While at the hospital, he mentioned that he saw an object crawling on his conjunctiva and removed it. He could not remember any specific event that initiated these symptoms. Upon examination by slit lamp, three larvae were seen and it was noted that they moved away from the light. The larvae (Figures A-C), measuring approximately .75mm in length, were removed and sent to the laboratory for identification. What is your diagnosis? Based on what criteria?
A 39-year-old female had a descending colon biopsy to determine the cause of symptoms that included chronic abdominal pain and discomfort. No pertinent travel history was known. Worm-like objects were detected during the biopsy, and some were recovered. The specimens were sent to the South Carolina state health department laboratory for identification. Lab personnel at the state took digital images (Figures A-C) and sent them to DPDx at CDC for assistance in making an identification via telediagnosis. What is your diagnosis? Based on what criteria?
A 28-year-old previously healthy man had a physical examination, including a chest x-ray, as one of his pre-employment requirements. The man had emigrated from Bulgaria approximately one year prior to the examination. The x-ray showed a cyst-like lesion in his right lung. The cyst was later surgically removed, and sent to pathology for identification. The cyst measured 3-4 cm in diameter. The following images were captured from a hematoxylin and eosin (H & E) stained section of the cyst. Figure A was captured at 40× magnification, and Figure B at 200×. What is your diagnosis? Based on what criteria?
A live worm was recovered from a 3-year-old's diaper. The child was healthy and had not traveled outside of the country. The worm was preserved in 10% formaldehyde and forwarded to the Swedish Institute for Infectious Disease Control (SMI) for examination. The worm's size was reportedly 6 cm long when first discovered, although when fixed, it measured 3.5 cm in length and 0.6 cm in width. Also due to fixation, the worm was brittle and had almost broke in half; no eggs or other structures came out of the broken area. At the tip of the thickest end, there was a crater-like opening with no apparent lips or teeth. Lab personnel at SMI captured images of the worm under a dissecting microscope and submitted a composite image, Figure A, to DPDx telediagnosis assistance. What is your diagnosis? Based on what criteria?
A public health laboratory sent images to DPDx for telediagnosis assistance to confirm their parasite identification of a 160 micrometer long object. The patient was a refugee from Africa. Figure A shows the object in a formalin-ethyl acetate (FEA) concentrated wet mount. What is your diagnosis? Based on what criteria?
A 75-year-old man had gastrointestinal bleeding while in Nigeria and received 8 units of whole blood that was reportedly imported from India. After his return to the United States two months later, he experienced fever (101º) and chills. Blood smears were submitted to a laboratory; one Plasmodium species was identified but assistance was requested for identification of a possible second species. Figures A-F were observed on a Wright's-Giemsa stained thin smear. What is your diagnosis and species determination? Based on what criteria?
DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.
- Page last reviewed: September 2, 2016
- Page last updated: September 2, 2016
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