January, 2004

Case 123:
An object was recovered from the stool of a 3-year-old child and was submitted to the child's physician.  The child was not symptomatic and had no travel history, but the family reported that cats were present in the child's home.  The physician submitted the specimen to CDC where laboratorians cleared the object with a solution of lacto-phenol over a period of two days.  Figure A shows the entire object which measured approximately 7 mm and Figure B shows the image of the object captured using a dissecting microscope.  Figures C and D show the object under a compound microscope at 40× and 200× magnification, respectively.  What is your diagnosis?  Based on what criteria?

A	B

C

D

Acknowledgement: This case kindly provided by Dr. Paul Bourbeau of Geisinger Medical Laboratories.

Click here for the answer to Case 123.

Case 124:
A member of the U.S. Armed Forces developed fever and chills upon returning to the United States.  The patient, while deployed in the Middle East, had been diagnosed with malaria approximately four months before this onset.  The patient was seen at a Veterans Administration Hospital; his physician requested examination of blood smears.  The laboratory reported the specimen positive for Plasmodium vivax.  The patient was treated and tested negative on his next blood smear.  Two months later, he returned to the hospital with fever and chills and, again, examination of blood smears was requested by his physician.  The Wrights-Giemsa stained smears were sent to CDC for confirmation, as well as whole blood collected in EDTA for additional confirmation by PCR analysis.  The following images were captured from those smears.  Figures A and B show what was observed on the thick smear.  Figures C-H show what was seen on the thin smear.  What is your diagnosis?  Based on what criteria?

A	B

C	D

E	F

G	H

Click here for the answer to Case 124.

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.