November, 2003

Case 119:
A 23 year-old male went to a local health department and requested screening as he believed he may have become infected with parasites while on a visit to Ecuador in September of this year.  He had no symptoms at the time of his visit to the health department.  A nurse complied with his request and instructed the man to submit a fecal specimen in 10% formalin for a routine ova and parasites (O & P) examination.  An formalin-ethyl acetate (FEA) concentration was performed and the objects in Figures A-C show what was observed in moderate numbers on a wet mount preparation of the sediment (Figure C has Lugol’s iodine solution).  What is your diagnosis?  Based on what criteria?

A	B

C

Acknowledgement: This case kindly provided by the North Carolina State Laboratory of Public Health.

Click here for the answer to Case 119.

Case 120:
A middle-aged man from East Africa, who had immigrated to the United States 20 years ago, had an intermittent fever for two weeks, which progressed to a daily fever with chills.  He had also experienced severe weight loss during the previous six months.  He had traveled to Southeast Asia while living outside the U.S., and his past medical history revealed he had contracted malaria twice.  It was also discovered that he was positive for HIV by antibody testing.  A CT scan revealed that he had an enlarged spleen and liver.  A bone marrow aspirate was obtained and part of it was stained with hematoxylin and eosin (H & E) and the rest used to inoculate a culture.  Figures A and B show what was seen in the stained aspirate.  Figures C and D show what was seen on a Giemsa stained smear from the culture 10 days postinoculation.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Acknowledgement: This case kindly provided Dr. Lisa Mahnke, Washington University School of Medicine, St. Louis, MO.

Click here for the answer to Case 120.

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving.  On rare occasions, clinical histories given may be partly fictitious.