Case #502 – October, 2019
Iron-hematoxylin stained thick blood films from an 18-year-old male resident of Equatorial Guinea were examined as a part of a field study. Two objects were detected in one blood film. The object at the top of the field shown in Figure A (magnified in Figure B) measured approximately 246 µm; the bottom object in Figure A (magnified in Figure C) measured approximately 198 µm. What is your diagnosis? Based on what features?
This is a case of dual infection by the filarial nematodes Loa loa and Mansonella perstans. These two species have overlapping distributions in some regions of Western and Central Africa. Adults of L. loa and M. perstans are typically found in subcutaneous tissues and the peritoneal cavity, respectively, and both species produce microfilariae which circulate in peripheral blood. Microfilariae are morphologically distinct and may be readily differentiated in stained blood films.
Key diagnostic features shown include:
- Size of microfilariae in stained blood films (L. loa: 230—250 µm; M. perstans: 190—200 µm)
- Presence or absence of a sheath (L. loa: present; M. perstans: absent)
- Tail morphology (L. loa: tapering, nuclei extending to tip; M. perstans: bluntly rounded, nuclei also extending to tip)
Images presented in the dpdx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
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/.