October, 2005

Case 165:
A woman went to a local emergency room due to fevers and chills.  She reported that she had traveled abroad to Burma and Thailand recently for three weeks.  When she traveled abroad previously, she had taken malaria prophylaxis that she received from a travel clinic, but she had not returned to the clinic before her most recent trip.  A blood film examination was ordered, and thick and thin smears were made and stained using ENG Scientific Malarial Quick Stain.  The hospital sent the smears to the Rhode Island Department of Health Laboratory for identification of species.  The RI laboratory sent images captured from the smears to the DPDx telediagnosis assistance for confirmation.  Figures A-D were captured at 1000× magnification.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Acknowledgement: This case was kindly contributed by the Rhode Island Department of Health Laboratory.

Click here for the answer to Case 165.

Case 166
A 13-year-old boy was seen by his pediatrician for watery diarrhea, abdominal cramping, and low-grade fever that had persisted for 3 days.  His symptoms began approximately 5 days after returning from a summer camp trip to a petting zoo.  The physician ordered an ova and parasites (O & P) exam.  The lab personnel followed their typical O & P procedure by performing an FEA concentration from formalin preserved stool and making wet mounts, and using PVA preserved stool to make trichrome stained smears.  Figures A and B show objects seen in low numbers on a wet mount (A) and the trichrome stained smear (B).  The round objects measured an average of 5 micrometers in diameter.  The laboratory reported a presumed diagnosis of parasitic protozoa.  What organism do you suspect?  Based on what criteria?  What, if anything, else needs to be done?

A	B

Click here for the answer to Case 166.

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.