June, 2005

Case 157:
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.  Although she had taken antimalarial drugs while she was abroad, she ceased prophylaxis when she returned to the United States.  While at the emergency room, the attending physician ordered a blood smear, which was stained with Wright-Giemsa and examined.  Figures A-F show what was observed on the thin smear at 1000× magnification.  What is your diagnosis?  Based on what criteria?

A	B

C	D

E	F

Acknowledgement: This case was kindly contributed by the San Diego County Health and Human Services.

Click here for the answer to Case 157.

Case 158:
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.  He explained to his physician that his symptoms began shortly before he returned to the United States.  An ova and parasites (O & P) examination was ordered, and Figures A-D show what was observed.  Figures A and B are from a wet mount stained with Lugol's iodine, and Figures C and D are from a trichrome stained fecal smear.  The objects ranged in size from 20-25 micrometers.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Click here for the answer to Case 158.

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.