Monthly Case Studies - 2006
Images from a trichrome stained fecal smear were submitted to DPDx telediagnosis assistance from a public health laboratory. Parasites were suspected and further confirmation was needed. The patient was a 32-year-old male who had diarrhea; no travel history was known. The objects in Figures A-D were present in moderately high numbers; images were taken at 1000× magnification. What is your diagnosis? Based on what criteria?
A 45-year-old woman had a nodule approximately 1 cm in diameter located near a scar from a previous mastectomy. The patient had traveled to several western and central European countries within the past year. The nodule was removed and tissue sections were stained with hematoxylin and eosin (H & E). Figures A-D show what was seen in the tissue sections. Figure A was taken at 50×, B at 100×, and Figures C and D at 400× magnification respectively. What is your diagnosis? Based on what criteria?
A request for confirmation of an identification was submitted to DPDx Telediagnosis Assistance. Figures A and B were captured from a hematoxylin and eosin (H & E) stained histological section of a liver abscess found during an autopsy. The patient had a travel history to Sri Lanka. What is your diagnosis? Based on what criteria?
DPDx Telediagnosis Assistance received a request for confirmation of an identification by the Vermont Department of Health Laboratory. Figures A and B show an object that was extracted from a chest wound of a patient. The object measured 7mm. The patient’s travel history was unknown. What is your diagnosis? Based on what criteria?
The DPDx Team received a telediagnosis request asking for confirmation of an identification made by the Wisconsin State Laboratory of Hygiene. The patient had a travel history to India. Figures A and B show objects seen on the thick blood smears stained with Wright-Giemsa. Figures C-G were taken from the thin smears. What is your diagnosis? Based on what criteria?
A 4-year-old boy's parents discovered a worm that they thought had been spit out by their child. They submitted the worm to their physician, along with the information that the boy had some exposure to raw seafood and that the family had a dog. The worm was eventually sent to a state public health laboratory and then CDC for identification. The worm was approximately 2 cm in length (see Figure A). The worm was cleared with lacto-phenol but defining morphologic features could not be seen. The posterior end was difficult to examine due to the cuticle being "rolled up" (see Figure B, 40× magnification). The anterior end was broken off (see Figure C, 40× magnification). A small cross-sectional slice of the worm was obtained with a scalpel and placed on a microscope slide with the cut side facing up. A small amount of lacto-phenol was placed around the section and a coverslip "floated" gently onto it, with additional solution along the edges of the coverslip to make an effective seal. Figure D, taken at 100× magnification shows what was observed in the section. What is your diagnosis? Based on what criteria?
A hospital submitted blood films to CDC's reference laboratory for identification of the microfilariae that were seen on the films. The object in Figure A was seen on a Wright-Giemsa stained blood film and measured approximately 180 µm. The object in B was seen on a Giemsa stained blood film and measured approximately 240-250 µm. Both A and B were taken at 500× magnification. What is your diagnosis? Based on what criteria?
A 35-year-old man was seen by a physician for diarrhea and abdominal pain. An ova and parasites (O & P) examination was ordered, along with other tests. The objects in Figures A and B were seen on a modified acid-fast stained stool smear and measured 8 to 10 µm. The images were taken at 1000× magnification. What is your diagnosis? Based on what criteria?
A man went to a local hospital with abdominal pain and weight loss. He reported that he frequently travels to South America and had previously been diagnosed with ascariasis, although recent stool specimens were negative. The laboratory saw the objects in Figures A, B, and C in the patient's stool samples. The objects measured 10 to 15 µm. Figure A was taken at 400× magnification from wet mount stained with iodine. Figures B and C were taken at 1000× magnification from a trichrome stained slide. What is your diagnosis? Based on what criteria?
A worm measuring approximately 11 mm in length was sent to CDC for identification by a laboratory in the Southeastern United States. The following images were obtained by placing the worm on a 1" × 3" glass slide and gently "floating" a 24 × 30 mm glass coverslip on top of it with water. Figure A shows the anterior end of the worm. Figures B and C (a digital zoom of B) show the posterior end of the worm. All images were captured at 100× magnification. Based on the images, identification at the genus level, as well as determination of whether the worm is male or female, is possible. What is your diagnosis? Based on what criteria?
A patient went to a local hospital with fevers and thrombocytopenia after recent travel to Haiti. A blood smear examination was requested by the attending physician. Figure A shows what was seen on a Wrights-Giemsa stained thin blood smear; the image was taken in a thicker area of the smear and low numbers of these objects were found in the smears. What is your diagnosis? Based on what criteria?
A family visited different U.S. states during a one week vacation. Approximately eight days after their trip, two family members began experiencing diarrhea. They went to their family physician and reported that while they were traveling they swam in hotel pools and at a waterpark. The physician requested stool samples for an ova and parasite (O & P) examination, along with other testing. The samples collected for the O & P were preserved in 10% formalin and then sent for examination. Figure A shows rounded objects seen on a modified acid-fast stained slide made from a formalin-ethyl acetate (FEA) concentrate of one of the specimens. The same objects were seen in specimens from the other family member who was ill. The objects measured 4.5-5.5 micrometers in diameter. What is your diagnosis? Based on what criteria?
A researcher was studying parasites of public health concern found in snails and slugs. A small portion of one specimen had tissue removed and placed in a small dish with a HCl/pepsin solution. Many larvae were observed in the dish, however most were dead or dying, but a few larvae were active. Figure A shows one of the active larvae in at wet mount captured at 200× magnification. Figure B shows a larva under differential interference contrast (DIC) microscopy at 400× magnification. What is your identification of the objects? Based on what criteria?
A patient was admitted to a hospital with a one-day history of fever and persistent headache on the right side. Approximately 10 days prior to the onset of symptoms, the individual swam in a small swimming hole, associated with a river. Two days after admission the patient developed a stiff neck, becoming progressively sleepy. The patient became lethargic and unresponsive to pain stimulation, and treatment with acyclovir and manitol was started. A computed tomography (CT) was performed and showed a lesion in the right frontal lobe and diffuse cerebral edema. The patient was pronounced dead 6 days after the onset of symptoms. Figures A and B are from hematoxylin and eosin (H & E) stained brain tissue specimens sent to CDC for confirmatory diagnosis. Objects shown Figure B ranged from 10 to 12 µm in diameter. What is your diagnosis? Based on what criteria? Which additional diagnostic test would you recommend to achieve a final diagnosis?
A 27-year-old woman who had been working in Laos, Thailand, and Vietnam for one and a half years was visiting relatives in the U.S. While she was in the U.S., she visited a physician for recurring abdominal discomfort, bloating, and frequent bowel movements that she had experienced over the last two months. The physician asked her to submit stool specimens for an ova and parasites examination (O & P). A wet mount preparation was made from a FEA concentration. Figure A, taken at 200× magnification, shows what was seen on the wet mount in low numbers. The size of the object was approximately 135 µm in length. What is your diagnosis? Based on what criteria?
A group of refugees from Southeast Asia were being screened for parasites as part of a medical evaluation. Stool specimens were collected and processed. Examination of a wet mount from a formalin-ethyl acetate (FEA) concentration of one individual's specimen revealed the object seen in Figure A. The objects were seen in low numbers and measured approximately 75 µm in length. What is your diagnosis? Based on what criteria?
A 29-year-old man went to a local health clinic with complaints of intermittent diarrhea for a few months. He did not report any other symptoms but said he had difficulty sleeping sometimes. A stool specimen was collected and preserved in both 10% formalin and polyvinyl-alcohol (PVA). An ova and parasite (O & P) examination was performed. Figure A shows what was seen on a concentrated wet mount preparation, and Figure B shows what was seen on a wet mount stained with iodine. Figures C and D show what was seen on a trichrome stained smear made from the PVA preserved specimen. Objects measured 7 to 10 µm in diameter. What is your diagnosis? Based on what criteria?
A 43-year-old man went to his physician complaining of fatigue. The man reported that he hiked and camped a lot throughout the northeastern United States weeks before the symptoms started. He also reported traveling to Kenya for vacation a month before his doctor's visit and stated that he had complied with the recommended malaria prophylaxis regimen. A blood examination was ordered, and a thick and thin blood film were made and stained with Giemsa. Figure A shows what was seen on the thick blood film, and Figure B shows the thin blood film. What is your diagnosis? Based on what criteria?
A CDC microbiologist was looking through slide boxes that had been archived to determine whether the slide quality was good enough to continue storing them. He came across a pathology slide of heart tissue that was dated "1929." Figures A-C show what was observed on the H & E stained preparation. What objects do you see in the images?
An elderly patient underwent a colonoscopy for polyps. A worm was seen near the appendiceal orifice and a biopsy was taken, fixed in formalin, and sent to histology. The sections were stained with hematoxylin and eosin (H & E). Figures A-C show what was observed on the slides at 100×, 400×, and 1000× magnification respectively. Objects such as the one shown in Figure C measured approximately 50 µm in length. What is your identification of this incidental finding? Based on what criteria?
A teenager underwent surgery for a traumatic injury to his abdominal cavity. Apart from the injury, the surgeon noticed some necrosis around the youth's appendix. A biopsy of that area was obtained and sent to the pathology department. Figures A-D show what was observed on one of the hematoxylin and eosin (H & E) stained slides of tissue section. Figures A, B and D were taken at 200×, and Figure C was taken at 400× magnification, respectively. What is your identification of this additional finding? Based on what criteria?
A 29-year-old missionary lived in Gabon and Cameroon for one year. Eight months into her stay, she went to a medical clinic with complaints of headache, fever, chills, and some diarrhea. She reported to the physician that she did not adhere consistently to her malaria prophylaxis regime. The physician ordered a blood film examination; thick and thin blood films were made and stained with Wright's. Figures A-D show objects that were seen on the thin blood film. What is your diagnosis? Based on what criteria? Would you recommend any laboratory confirmatory test to make the diagnosis specific?
A 45-year-old female noticed a long, worm-like object in her stool. The object was collected and, along with tissue sections prepared by the hospital where she was seen, submitted to the Florida public health laboratory for examination. The specimens were forwarded to CDC's parasitology diagnostic reference laboratory for identification. Examination methods were: whole worm was examined for morphologic features (Figure A); a portion of the worm was removed (Figure B), cleared using lacto-phenol solution, flattened using two 2" by 3" glass slides, and examined under a dissecting microscope (Figure C); and the proglottid was ruptured to release some of the eggs and examined with a compound microscope. Images of the eggs were captured at 40× (Figure D), 100× (Figure E), and 200× (Figure F) magnification. What is your identification? Based on what criteria? Would you recommend any additional confirmatory diagnostic testing?
Recently DPDx telediagnosis inquiries received a request for assistance from the Medical College of Wisconsin. Images from a thin blood smear were submitted along with the patient's history of traveling to Honduras. Figures A-E show what was seen on the thin blood film. What is your diagnosis? 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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