July, 2004

Case 135:
A 23-year-old man spent 9 months in Kenya.  He reported taking doxycycline for prophylaxis while in Kenya, however he poorly adhered to this daily regimen.  Upon his return to the United States, he saw a doctor due to fevers.  It was determined from the patient's blood that he had a low platelet count and a normal liver function.  Blood films were made from a finger stick, stained with Giemsa, and examined.  The objects below were observed in the thick (Figures A and B) and thin (Figures C-F) blood films under oil immersion 1000×.  What is your diagnosis?  Based on what criteria?

A	B

C	D

E	F

Acknowledgement: This case was kindly provided by the Wisconsin State Laboratory of Hygiene.

Click here for the answer to Case 135.

Case 136:
A 32-year-old man visited the Philippines for a month, traveling throughout the major islands on nature tours.  Nine months after his trip, he visited his physician due to a small lump in his groin.  He did not have discharge or discomfort from the nodule.  The patient was referred to an infectious disease physician who ordered a blood film examination; the patient's blood was drawn during evening hours.  The object in Figure A was seen on a Giemsa stained thick smear (magnification 400×), and the object in Figure B was observed on a Giemsa stained thin smear (magnification 500×).  The objects measured approximately 215 micrometers long.  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 136.

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.