April, 2006

Case 177:
A 43-year-old man went to his physician complaining of fatigue.  The man reported that he hiked and camped a lot throughout the northeastern United States weeks before the symptoms started.  He also reported traveling to Kenya for vacation a month before his doctor's visit and stated that he had complied with the recommended malaria prophylaxis regimen.  A blood examination was ordered, and a thick and thin blood film were made and stained with Giemsa.  Figure A shows what was seen on the thick blood film, and Figure B shows the thin blood film.  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 177.

Case 178:
A 29-year-old man went to a local health clinic with complaints of intermittent diarrhea for a few months.  He did not report any other symptoms but said he had difficulty sleeping sometimes.  A stool specimen was collected and preserved in both 10% formalin and polyvinyl-alcohol (PVA).  An ova and parasite (O & P) examination was performed.  Figure A shows what was seen on a concentrated wet mount preparation, and Figure B shows what was seen on a wet mount stained with iodine.  Figures C and D show what was seen on a trichrome stained smear made from the PVA preserved specimen.  Objects measured 7 to 10 µm in diameter.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Click here for the answer to Case 178.

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.