2005 Monthly Case Studies
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
A live worm was recovered from a 3-year-old's diaper. The child was healthy and had not traveled outside of the country.
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.
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.
DPDx is an educational resource designed for health professionals and laboratory scientists. For an overview including prevention, control, and treatment visit www.cdc.gov/parasites/.