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Monthly Case Studies - 2007

December 2007

	Case218_A

December - 2007 - Case #218

A 52-year-old man was seen at a hospital for fever and chills. He reported travel to wooded areas in the Northeastern United States and noted previous tick bites. For the last case study of the year, you do not have to make a diagnosis since Babesia sp. was identified on a Giemsa-stained blood smear by the hospital laboratory staff. However, the attending physician would like a parasitemia value to determine how best to manage the care and treatment of the patient. Using the images provided, please calculate the parasitemia.

	Case217_A

December - 2007 - Case #218

A 29-year-old man, with a history of travel to Rwanda, was seen at a local health clinic for fever, headache, mild nausea, and chills. A blood smear was prepared, stained with Giemsa, and examined at 1000× magnification. Figures A and B show what was seen on the thin blood smear. What is your diagnosis? Based on what criteria?

November 2007

	Case216_A

November - 2007 - Case #216

An asymptomatic, 35-year-old male with no known travel history went to his physician at a wellness clinic for a routine examination. An ova and parasite (O & P) examination was performed as part of the laboratory work-up at the State Health Laboratory. Unusual objects were observed in the formalin-concentrated stool, and the specimen was sent to CDC for diagnostic assistance and possible identification. Figures A-D were captured from wet mounts of the specimen. The objects measured approximately 50 micrometers by 42.5 micrometers. What is your diagnosis? Based on what criteria?

	Case215_A

November - 2007 - Case #215

A 33-year-old Lithuanian woman had swellings in various regions of her body that developed over the last two years. She reported that she worked as a cook, and she also stated she had traveled to Kazakhstan three years ago. A biopsy was taken from a tumor over her right eye lid and was sent to a local pathology laboratory for further examination. Sections were stained with hematoxylin and eosin (H & E) stain. Figures A-D were captured from the sections and emailed to DPDx for diagnostic assistance. What is your diagnosis? Based on what criteria?

October 2007

	Case214_A

October - 2007 - Case #214

An 18-year-old woman sought medical attention due to a painful lesion between her toes. She reported travel to Africa. The lesion was excised and sent to CDC for closer examination and identification. The tissue was noted to be fibrous and was carefully dissected to examine what was inside. Figure A shows what was revealed within the tissue; the image was taken with a hand-held digital camera mounted to a dissecting microscope. What is your diagnosis? Based on what criteria?

	Case213_A

October - 2007 - Case #213

A 49-year-old man, with no known travel history, had a colonoscopy. His physician observed small worms during the procedure that were 3 to 4 mm in length. The worms were submitted to a pathology laboratory for sectioning and staining. Figures A-C were captured from hematoxylin and eosin (H & E) stained sections; A was taken at 100× magnification and B and C were taken at 200× magnification. Images were sent to DPDx for diagnostic assistance along with a presumed diagnosis based on the size and morphologic features. The DPDx Team requested more information on the size of the oval structures (Figure C, blue arrows) and were told that they were approximately 50-55 micrometers in length. What is your diagnosis? Based on what criteria?

September 2007

	Case212_A

September - 2007 - Case #212

A 49-year-old man, with no known travel history, had a colonoscopy. His physician observed small worms during the procedure that were 3 to 4 mm in length. The worms were submitted to a pathology laboratory for sectioning and staining. Figures A-C were captured from hematoxylin and eosin (H & E) stained sections; A was taken at 100× magnification and B and C were taken at 200× magnification. Images were sent to DPDx for diagnostic assistance along with a presumed diagnosis based on the size and morphologic features. The DPDx Team requested more information on the size of the oval structures (Figure C, blue arrows) and were told that they were approximately 50-55 micrometers in length. What is your diagnosis? Based on what criteria?

	Case211_A

September - 2007 - Case #211

A 10-year-old boy from India was tested for malaria by blood smear examination. The commercial laboratory that reviewed the smears forwarded them, along with EDTA blood, to their state health department for consultation. Figures A and B show what was seen on the original stained slides made by the commercial laboratory. Figures C and D show what was seen on the slides made by the state health department. Figures A-D were taken by the state and sent to DPDx for diagnostic assistance. In a follow-up email, the state health department stated that the patient had been treated before the blood was obtained. A preliminary diagnosis was made by the DPDx Team which was sent to the state health department, along with a request for the stained smears and EDTA blood for possible molecular testing. Figures E and F were taken from a stained thick smear; Figures G and H were taken from a stained thin smear. Upon reviewing the smears, DPDx Team members also observed the same object that appears in Figure C. What is your diagnosis? Based on what criteria?

August 2007

	Case210_A

August - 2007 - Case #210

A 32-year-old man went to his health care provider with complaints of bloating, intermittent diarrhea, and abdominal cramping. He stated he liked to go camping and hunting and sometimes consumed the fish and game that he caught. The man was asked to provide a stool specimen for testing. The laboratory that performed the testing made a wet mount after using a concentration procedure. Figures A and B show what was observed in low numbers on the slide. The objects ranged in size from 45 to 58 micrometers in diameter. What is your diagnosis? Based on what criteria?

	Case209_A

August - 2007 - Case #209

A 54-year-old Haitian man was admitted to a hospital emergency room with back pain and fever. Blood was collected, and slides were made and stained with Giemsa. Figures A-D show what was observed on a stained slide at 1000× magnification using oil immersion. These images were submitted to DPDx for diagnostic confirmation. What is your diagnosis? Based on what criteria?

July 2007

	Case208_A

July - 2007 - Case #208

A 29-year-old Peace Corp volunteer returned to the United States from Malawi with symptoms that included mild gastrointestinal cramping and intermittent blood in his urine. He sought medical care and the physician ordered a battery of tests including ova and parasite examinations on stool and urine specimens. Figure A shows what was observed on a wet mount of urine sediment. The object was approximately 150 micrometers in length. What is your diagnosis? Based on what criteria?

	Case207_A

July - 2007 - Case #207

Images captured from a trichrome stained smear were submitted to DPDx for diagnostic assistance. The smears were made from a polyvinyl-alcohol (PVA) preserved fecal specimen, but no other patient or specimen information was given. The submitter wanted confirmation for one parasite they had identified and was not sure of the other organism observed on the smear. Figures A-C show the objects in question under 1000× magnification. All images were cropped to the same dimensions by DPDx. What is your diagnosis? Based on what criteria? What valuable information would have been useful if provided?

June 2007

	Case206_A

June - 2007 - Case #206

An immigrant from West Africa arrived in the United States after living in Liberia and Sierra Leone. The individual was admitted to a medical center with shortness of breath and pulmonary tuberculosis was suspected. An x-ray was ordered, an acid-fast bacillus (AFB) smear was made, and blood was collected to determine platelet counts and hemoglobin level. A Wright-Giemsa stained blood smear was made and reviewed; the objects seen on the thin smear were approximately 250 µm (based on the relative size of the white blood cells). Figures A and B show the same organism, captured from the thin smear at 250× and 1000× magnification respectively. Figures C and D were both taken at 1000× magnification. What is your diagnosis? Based on what criteria?

	Case205_A

June - 2007 - Case #205

A 30-year-old man from Sudan had fever and chills. He was also mildly jaundiced. He went to his physician who ordered a blood smear examination. Smears were made and stained with Leishman's stain. Figures A-E were captured from the thin smears. What is your diagnosis? Based on what criteria?

May 2007

	Case204_A

May - 2007 - Case #204

A mother found objects that she thought were maggots in the diaper of her 10-month-old child. She submitted the specimens to her state health department for identification and advice. Figures A and B show the submitted specimens using a low power dissecting microscope. The smaller white objects were released when one of the specimens was dissected, and two of the objects are shown in Figures C and D at 400× magnification using a compound microscope. These objects measured 200-250 micrometers and contained individual structures measuring approximately 40 micrometers. Digital images were captured and sent to DPDx for confirmation. What is your diagnosis? Based on what criteria?

	Case203_A

May - 2007 - Case #203

Giemsa-stained thick and thin blood smears were examined as part of a screening protocol for refugees from a country that has areas of ongoing malaria transmission. Figures A and B were captured from the thick smear; Figures C and D were captured from the thin smear. What is your diagnosis? Based on what criteria?

April 2007

	Case202_A

April - 2007 - Case #202

A patient was seen at a hospital in Rwanda with headache, fever, and chills. A thin blood smear was made, stained with Giemsa, and examined. Figures A-F show what was seen on the smear at 1000× magnification. What is your diagnosis? Based on what criteria

	Case201_A

April - 2007 - Case #201

A 49-year-old Filipino man had an intestinal tissue biopsy taken. Figures A-C show what was seen on slides stained with hematoxylin and eosin (H & E). Figure A was taken at 100× magnification, Figure B was taken at 400× magnification, and Figure C (of a different section) was taken at 1000× magnification. Figure D was taken from a wet mount slide of formalin preserved stool; the object of interest in Figure D is approximately 40 micrometers long by 20 micrometers wide. What is your diagnosis? Based on what criteria?

March 2007

	Case200_A

March - 2007 - Case #200

Approximately one and a half months after a trip to Costa Rica, a man developed a papule on the back of his right hand. The papule progressed to a 2 cm ulcer with a raised border. The ulcer was not tender but was draining serous fluid, and the surrounding skin was red and swollen. A second, similar eruption occurred on the same hand, and the man sought medical attention. His physician gathered clinical and travel history, examined the lesions, and contacted the Division of Parasitic Diseases for assistance. Tissue scrapings and a punch biopsy were collected. Suspicious objects were reported by the pathologists who reviewed the slides. Specimens were sent to DPD’s reference diagnostic laboratory for review. Figures A-C, taken at 1000× magnification, show what was seen on a Giemsa stained smear of a tissue scraping. What is your diagnosis? Based on what criteria? What other testing, if any, is indicated?

	Case199_A

March - 2007 - Case #199

A huntsman killed a bear and prepared it for eating and freezing by cutting it into roasts, steaks, and grinding the trimmings. Later that same day, he ate a burger made from some of the fresh meat and cooked rare. Approximately two and a half to three weeks later, the hunter experienced fever, diarrhea, and muscle pain. However, medical attention was not sought for another six weeks. He had elevated eosinophilia and several laboratory tests were ordered. The Division of Parasitic Diseases' reference diagnostic laboratory received some of the bear meat for examination. A digestion technique using 0.1% pepsin and 0.1% hydrochloric acid was used on the meat and a muscle squash was made from the softened tissue. Figure A, taken at 400× magnification, and Figures B-E, taken at 1000× magnification, show what was observed. What is your identification of the objects in the meat? What is your diagnosis? Based on what criteria?

February 2007

	Case198_A

February - 2007 - Case #198

A 28-year-old male immigrant who had resided in Spain for the last five years, went to a physician complaining of general malaise and itching. The patient had slight eosinophilia but 15 days later was asymptomatic with no alteration in the differential blood count. Ova and parasite examinations of three stool specimens were negative, and the patient had an ultrasound of the biliary tract and abdomen showed no abnormalities. The patient admitted to regularly eating liver of locally raised sheep and cattle. Figures A-C show what was seen in a concentrated stool sample; the objects measured 37 to 45 micrometers by 25 micrometers. What is your diagnosis? Based on what criteria?

	Case197_A

February - 2007 - Case #197

The Division of Parasitic Diseases' reference diagnostic laboratory received a specimen from a state health department for confirmatory review. The only patient information given was that the patient had traveled to Nigeria. Figures A-C show what was seen on a stained thin blood smear. What is your diagnosis? Based on what criteria?

January 2007

	Case196_A

January - 2007 - Case #196

A missionary traveled to various countries in sub-Saharan Africa for one year. He went to his physician complaining of abdominal pain and occasional diarrhea which he experienced since his return to the U.S. He reported he swam in various lakes while he was abroad. An ova and parasite (O & P) stool examination revealed objects, measuring 135 µm, like the one shown in Figures A and B (200×). The images show the same area of the slide but two separate focal planes. What is your diagnosis? Based on what criteria?

	Case195_A

January - 2007 - Case #195

A patient complaining of intermittent symptoms including coughing up blood, fever, and other vague "flu-like" symptoms saw a physician. The patient reported working at a sushi restaurant and eating a raw crab on a dare (Figure A shows a crab similar to the one that the patient ate). Blood tests were ordered and results included peripheral eosinophilia of 10% and a history of bilateral pneumothorax (free air or gas in the pleural cavity). A biopsy yielded a cyst containing a structure 5 mm in length and 2 mm in width. Figure B (40×) and Figure C (100×) show a hematoxylin and eosin (H & E) stained section of the specimen. Figure D (400×) shows an object which measured 80-90 µm by 40-45 µm. Similar objects were found in low numbers in sections of lung tissue. 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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