November, 2005

Case 167:
A 45-year-old woman went to her physician with complaints of recurring abdominal cramping, bloating, and infrequent diarrhea.  Her travel history included a 10-day camping trip in Alaska, and her symptoms had started approximately 2 weeks after her return.  Her physician ordered an ova and parasites (O & P) examination.  Figures A-D show objects observed on a trichrome stained fecal smear; A-C were found in moderate numbers on the smear, while D was found in very few numbers.  The objects shown ranged in size from 5 to 7 micrometers.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Click here for the answer to Case 167.

Case 168:
In April 2005, DPDx telediagnosis inquiries received a request for assistance from the Oregon State Public Health Laboratory.  Images from a thick and thin blood smear were submitted.  Based on information that came with the specimen, the smears were most likely stained with Giemsa.  The only case history available was that the patient lived in Africa until the beginning of this year.  Figures A-C show what was observed on the thick smear.  Figure C is a close-up of the posterior end of the object in Figure B.  Figures D-F show what was observed on the thin smear.  In Figure D, the object measured 300 micrometers; close-ups of the posterior and anterior ends are shown in Figures E and F, respectively.  What is your diagnosis?  Based on what criteria?

A	B

C

D

E

F

Acknowledgement: This case was kindly contributed by the Oregon State Public Health Laboratory.

Click here for the answer to Case 168.

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.