September, 2007

Case 211:
A 10-year-old boy from India was tested for malaria by blood smear examination.  The commercial laboratory that reviewed the smears forwarded them, along with EDTA blood, to their state health department for consultation.  Figures A and B show what was seen on the original stained slides made by the commercial laboratory.  Figures C and D show what was seen on the slides made by the state health department.  Figures A-D were taken by the state and sent to DPDx for diagnostic assistance.  In a follow-up email, the state health department stated that the patient had been treated before the blood was obtained.  A preliminary diagnosis was made by the DPDx Team which was sent to the state health department, along with a request for the stained smears and EDTA blood for possible molecular testing.  Figures E and F were taken from a stained thick smear; Figures G and H were taken from a stained thin smear.  Upon reviewing the smears, DPDx Team members also observed the same object that appears in Figure C.  What is your diagnosis?  Based on what criteria?

A	B

C	D

E	F

G	H

Acknowledgement: This case was kindly contributed by the Florida Department of Health, Bureau of Laboratories.

Click here for the answer to Case 211.

Case 212:
A 38-year-old man sought medical attention because of rectal bleeding.  His only reported travel was to Laos two years ago.  A colonoscopy was performed and based upon what was found during the procedure, he was given a presumptive diagnosis of tapeworm.  The largest object recovered during the colonoscopy measured approximately 0.7 cm in length and 0.05 cm in diameter.  Figures A and B, taken at 100× and 400× magnification respectively, were two of the images submitted to DPDx for diagnostic assistance.  The DPDx Team concurred with the presumptive diagnosis but required actual specimens for examination to make a more specific identification.  Figures C-E, taken at 100×, 400×, and 1000× (oil) magnification respectively, show what was observed on the hematoxylin and eosin (H & E) stained slide sent to CDC.  The round to oval structures measured 35 to 40 micrometers in diameter.  What is your diagnosis?  Based on what criteria?

A	B

C	D

E

Acknowledgement: This case was kindly contributed by CBM Pathology in Maryland.

Click here for the answer to Case 212.

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.