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Answer to Case 657
 Answer to theParasite Case of the Week 657:Plasmodium vivaxThanks to all of the great comments on this case! There are so many classic features ofP. vivaxhere, that it makes for a fabulous teaching slide. Florida Fan very nicely outlined all of the diagnostic features along with his thought process for coming to the final identification:1/ The ring is fairly large, and the infected red cell is larger than the not infected. As such, there is a predilection for reticulocytes. Either P. vivax or P. ovale.2/ The mature trophozoites are ameboid form, showing them to be highly Vivacious. More than likely P. vivax.3/ The sc...
Source: Creepy Dreadful Wonderful Parasites - October 18, 2021 Category: Parasitology Source Type: blogs

Case of the Week 656
 It ' s time for our monthly case with Idzi Potters and theInstitute of Tropical Medicine, Antwerp:The following was seen in a urine sediment from a backpacker returning to Belgium following a 2-month ' s trip in Northern Senegal. During his travels, he reports being bitten by insects, drinking and eating local foods, and swimming in fresh water lakes. He is asymptomatic, but is concerned that he may has picked up a parasite along the way. How would you interpret this finding? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - October 5, 2021 Category: Parasitology Source Type: blogs

Answer to Case 656
 Answer to theParasite Case of the Week 656: mite, probable contaminant from the environment. Not likely of human medical significance.As several readers noted, this mite is not one of the 2 human pathogenic mites,Sarcoptes scabeiorDemodex. Instead, it is likely a mite from the environment, such asDermatophagoides, the dust mite. The presence of many squamous epithelial cells in the background would support this idea:You can read the following posts for more information for how to differentiate the various mites found in human specimens:Case of the Week 634: Free-living mite found in stoolCase of the Week 196: Differe...
Source: Creepy Dreadful Wonderful Parasites - October 4, 2021 Category: Parasitology Source Type: blogs

Case of the Week 655
 This week ' s case features small (~2 micrometer long), oval-shaped objects seen in a corneal scraping. Thanks to Heather for taking these beautiful images. The stain is strong trichrome (chromotrope 2R method). What is the most likely diagnosis? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - September 27, 2021 Category: Parasitology Source Type: blogs

Answer to Case 655
Answer to theParasite Case of the Week 655: Microsporidia spores. Nucleic acid amplification/sequencing and/or electron microscopy is required for genus and species level identification.Microsporidia that are commonly implicated in corneal infection include Vittaforma corneaeandEncephalitozoon hellem.As noted by Dr. Harsha Sheorey, the Ryan ’s modified Trichrome stain was created by his friend and colleague, Dr Norbert Ryan. This stain has now become a standard staining technique for these organisms, and what was used in this case. The microsporidia spores stain bright red against a blue background.  (Sour...
Source: Creepy Dreadful Wonderful Parasites - September 26, 2021 Category: Parasitology Source Type: blogs

Case of the Week 654
 This week ' s case is of a middle-aged man with a painful lesion on the dorsum of his foot. He recently returned from Brazil, during which he swam in the ocean, walked barefoot on the beach, and ate local foods. An excisional biopsy was performed and submitted to the clinical microbiology lab to rule out a possible parasite. The specimen received was an excised ellipse of skin on which there was a central defect measuring ~ 5 mm in diameter:There was also a separate section of subcutaneous tissue, which contained numerous tan-white ovoid objects:Here is a close-up of these objects:To confirm our suspected diagnosis, ...
Source: Creepy Dreadful Wonderful Parasites - September 20, 2021 Category: Parasitology Source Type: blogs

Answer to Case 654
 Answer to theParasite Case of the Week 654:Tungasp. fleaI encourage you to check out the posts in the Comments section by Kosta and Florida Fan who give us an excellent description of the taxonomy, morphology, epidemiology, and clinical presentation of this parasitic flea. Here are some of the diagnostic features from this case:Tungasp. eggs measuring ~0.6 mm long:Egg within the body of the flea, along with other characteristic features:We weren ' t able to locate the head of the flea, so there is a chance that it is still embedded in the skin of the host. This is not usually of significant concern, however, as ...
Source: Creepy Dreadful Wonderful Parasites - September 19, 2021 Category: Parasitology Source Type: blogs

Case of the Week 653
 This week ' s case was generously donated by Drs. Alex Fenwick and Julie Ribes at the University of Kentucky. The following structure was retrieved from bronchial washings of a patient with end-stage lung disease due to cystic fibrosis.  The next 2 images show both ends of this object.Most likely identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - September 13, 2021 Category: Parasitology Source Type: blogs

Answer to Case 653
 Answer to theParasite Case of the Week 653: Not a human parasite; most likely a mucus cast.As noted by Florida Fan, " The object did not have any internal organization nor visible external anatomy. It displays a ribbon like morphology being flat and slender especially at the bend. " Sam had a similar thought and suggested that since the " patient had cystic fibrosis it may be some kind of mucous plug. "  To test these hypotheses, we can gently manipulate the object. Mucus usually separates easily whereas a true nematode has a firm, rubbery cuticle and is harder to tear. As CA noted, although not a firs...
Source: Creepy Dreadful Wonderful Parasites - September 12, 2021 Category: Parasitology Source Type: blogs

Case of the Week 652
Happy Labor Day weekend to my American readers! It ' s the first Monday of the month, and time for our monthly case from Idzi Potters and theInstitute of Tropical Medicine, Antwerp. The following structures were seen in Ziehl-Neelsen stained sputum specimen for acid fast bacilli, thus prompting additional examination of direct wet mounts. The patient had recently from Sicily. Ziehl-Neelsen stained sputum specimen:Direct wet mount:Identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - September 6, 2021 Category: Parasitology Source Type: blogs

Answer to Case 652
 Answer to theParasite Case of the Week 652:Strongyloides stercoralisL3 (filariform) larvae.As nicely described by Luis, " We can see in photo 2 an esophagus almost as long as the intestine, the tail is sharp and has notches (photo 3). "The notches are classic and can be seen in both the the Ziehl-Neelsen (ZN) stained preparation and wet prep (inset), (arrows). The ZN stain had been performed to screen for acid fast bacilli (AFB). AFBs would stain bright red with the carbol fuchsin dye, whereas the larva is only stained here with the methylene blue counter stain. This case goes well with last week ' s, in wh...
Source: Creepy Dreadful Wonderful Parasites - September 6, 2021 Category: Parasitology Source Type: blogs

Case of the Week 651
 This week ' s case is from Dr. Ioana Bujila and her colleagues at the Department of Parasitology at the Swedish Public Health Agency. The following were seen in a formalin-ethyl acetate concentration of feces from a young girl with recent travel to India. Some of these hardy eggs contained live larvae - despite the formalin:Identification? Any additional tests that you would like to conduct? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 30, 2021 Category: Parasitology Source Type: blogs

Answer to Case 651
Answer to theParasite Case of the Week 651:Strongyloidessp. rhabditiform larvae, as evidenced by the short buccal cavity and genital primordium. ALSO in this interesting case are unembryonated and fully embryonated eggs. Eggs are NOT usually shed in the stool inStrongyloides stercoralisinfection. So how do we explain these findings? Are theseStrongyloideseggs? Or something else? Is there a mixed infection here?Based on my own interpretation and your comments, I ' ve come up with the 5 possible scenarios to explain the findings in this case:Scenario 1. Both the larvae and eggs are those ofS. stercoralis.As mentioned ab...
Source: Creepy Dreadful Wonderful Parasites - August 29, 2021 Category: Parasitology Source Type: blogs

Case of the Week 650
Greetings from New England! I ' m on vacation this week, so this will be a very short case - courtesy of Dr. Seema Jabbar. The following was " coughed up " by a patient. Most likely identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 24, 2021 Category: Parasitology Source Type: blogs

Answer to Case 650
Answer to theParasite Case of the Week 650: MaleAscaris lumbricoidesAs nicely stated by Florida Fan, " Ah Ha, once more the male round worm finds its way out. Judging by the curved tail and the size, it ’s a male Ascaris lumbricoides. The female is longer and larger with a straight tail. Hopefully this is the only one in the patient, and though terrifying, it’s good riddance for the host. " A. lumbricoidesfemales can be up to 35 cm long (range of fully mature females is 20-35 cm), whereas males are slightly smaller at 15-30 cm long. Adults usually reside in the small intestine, but can occasionally migra...
Source: Creepy Dreadful Wonderful Parasites - August 23, 2021 Category: Parasitology Source Type: blogs