Case of the Week 693
 This week ' s case was kindly donated by Dr. Mike Mitchell and his laboratory. The patient is a middle-aged man with fever, intermittent cough, headache and mental status changes. He had a history of lymphoma and was receiving maintenance immunosuppressive chemotherapy. Of note, he had several episodes of bacteriemia and progressively worsening pulmonary infiltrates. He was originally from Sub-Saharan Africa but had been living in the United States for several decades. The following are images from a duodenal aspirate:What is your diagnosis? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 22, 2022 Category: Parasitology Source Type: blogs

Answer to Case 693
Answer toParasite Case of the Week 693:Strongyloides stercoralislarvaeAs many of you mentioned, the large number of larvae is very concerning for strongyloides hyperinfection, so an urgent call to the treating physician is indicated. The single larva seen here is an rhabditiform (L1) larva. It has a short buccal canal (shown) and prominent genital primordium. (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 22, 2022 Category: Parasitology Source Type: blogs

Case of the Week 692
 This week ' s case is a bit different in that it wasn ' t actually alive. Instead, it is a stunning glass artwork of an object that is important in the world of human clinical parasitology. What am I showing here? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 17, 2022 Category: Parasitology Source Type: blogs

Answer to Case 692
Answer to theParasite Case of the Week 692: Female copepod with aDracunculus medinensislarva inside. This stunning glass art was made byJane Hartman(@trilobiteglass) and gifted to me by my friend and colleague, Dr. Audrey Schuetz (@schuetz_audrey). Here are some of the key features:This case is particularly special since it was the topic of the very first unknown case I ever posted on this blog - way back in 2007! You can see it here:Parasite Case of the Week 1.Thanks to everyone who has stuck with me along the way - 7 years and 691 posts later! - and to those of you who have joined along the way. (Source: Creepy Drea...
Source: Creepy Dreadful Wonderful Parasites - August 14, 2022 Category: Parasitology Source Type: blogs

Case of the Week 691
This week ' s case was generously donated by Dr. Nicole Brammer Hubbard. Several of the following objects were removed from ear of a child after the parents noticed a bloody discharge (!)  Identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 9, 2022 Category: Parasitology Source Type: blogs

Answer to Case 691
 Answer toParasite Case of the Week 691: Fly larva, consistent withLuciliaspecies, (or as Florida Fan noted, " I love Lucy! " ) There are numerous keys for identifying fly larvae, including the freely-available CDC pictorial keys (https://www.cdc.gov/nceh/ehs/publications/pictorial_keys.htm) and a simplified key that Blaine and I published in our review onLaboratory Identification of Arthropod Ectoparasites (Clinical Microbiology Reviews). These keys are very easy to use once one is familiar with the basic morphologic parts of fly larvae (e.g., spiracular plates, mandible). Identification to the species...
Source: Creepy Dreadful Wonderful Parasites - August 8, 2022 Category: Parasitology Source Type: blogs

Case of the Week 690
This week ' s case is in honor of @JMGardner who showed a beautiful example of this finding a little while ago. This one is not quite as good, but still diagnostic. The digital slide can be viewedHERE. This is a low power view:What information can be gleaned from this biopsy, and what would have been the preferred method for identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - August 1, 2022 Category: Parasitology Source Type: blogs

Answer to Case 690
 Answer: Embedded hard tick, partially engorged with blood. As noted by Florida Fan, it is unfortunate that this tick was sectioned for histopathology, since " we need to examine the anal groove, the shield, the palpi, and the basis capitulum " in order to identify the tick to the genus and species level. This level of identification is helpful for patient management, since different species serve as vectors for different microorganisms. Additionally, finding an engorgedIxodes scapularisin a region of high Lyme disease endemicity may prompt antibiotic prophylaxis in certain situations. Without being able to ...
Source: Creepy Dreadful Wonderful Parasites - July 31, 2022 Category: Parasitology Source Type: blogs

Case of the Week 689
 This week ' s case is from a middle-aged woman with unexplained small bowel perforation. Here is the section with the culprit. You can view the whole slide imageHERE. What is your diagnosis? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - July 18, 2022 Category: Parasitology Source Type: blogs

Answer to Case 689
 Answer to theParasite Case of the Week 689:  Anisakid, most consistent with anAnisakisspecies.Hopefully you all had a change to look at the whole slide imageHERE. From its location in the small intestine, deep in the submucosa, one can envision how it may have extended through the wall of the intestine and caused a perforation. Dr. Luca Fanasca noted that " we can clearly see features consistent with an anisakid infection: multilayered cuticle (from a portion which seems detached, in the upper part), polymyarian muscle cells, the beautiful Y shaped lateral chords and the banana-shaped excretory cell. From t...
Source: Creepy Dreadful Wonderful Parasites - July 17, 2022 Category: Parasitology Source Type: blogs

Bedtime Reading?
For those of you looking for some good (?) bedtime reading, you may be interested in two fun articles that Blaine Mathison and I recently wrote:Blaine A. Mathison, Bobbi S. Pritt, Sleeping with the Enemy: Everything You Need to Know about the Biology, Clinical Significance, and Laboratory Identification of Bed Bugs. Clinical Microbiology Newsletter, Volume 43, Issue 1, 2021, Pages 1-7,https://www.sciencedirect.com/science/article/pii/S019643992030091XBlaine A. Mathison, Bobbi S. Pritt,Don ' t Be a Nit Wit; Know Your Lousy Companions! Clinical Microbiology Newsletter, Volume 44, Issue 13, 2022, Pages 115-122,https...
Source: Creepy Dreadful Wonderful Parasites - July 12, 2022 Category: Parasitology Source Type: blogs

Case of the Week 688
This week ' s case features an object (of many) found in the hair of a 6-year-old girl. Identification? (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - July 5, 2022 Category: Parasitology Source Type: blogs

Answer to Case 688
 Answer to theParasite Case of the Week 688: Nit (egg) ofPediculus humanus capitis. As noted by Kosta Mumcuoglu, " it is the egg of the head louse,Pediculus humanus capitiswith the embryo inside (legs visible) and the operculum still on the egg. We can also see the part of the glue which was used to attach the egg on the hair. The aeropyles are in a row while in case of the pubic louse eggs they are in a triangular order. Seehttps://www.veterinaryparasitology.com/pthirus-pubis.html but alsoCase 293 in Creepy Dreadful Wonderful Parasites. It is by the wayPthirusnotPhthirus pubis. " Kosta is correct on al...
Source: Creepy Dreadful Wonderful Parasites - July 5, 2022 Category: Parasitology Source Type: blogs

Case of the Week 687
 This week ' s case is generously donated by Dr. Ioana Bujila of the Public Health Agency of Sweden. The patient is a 67 year old woman from Gabon. Blood was examined by direct mount and Giemsa-stained blood films, and the following were identified:These objects are approximately 228 micrometers in length.What is your diagnosis? Are there any additional laboratory analyses that are recommended in this case?  (Source: Creepy Dreadful Wonderful Parasites)
Source: Creepy Dreadful Wonderful Parasites - June 27, 2022 Category: Parasitology Source Type: blogs

Answer to Case 687
 Answer toParasite Case of the Week 687: Loa loaAs noted by Florida Fan, @JuanCGabaldon, Idzi P, Ulrike E. Zelck, Priyanka Gupta, and others, the video clearly shows this to be a sheathed microfilaria, and the Giemsa smear shows the column of nuclei extending all the way to the tip of the tail, thus allowing us to make an identification of Loa loa. The patient ' s travel history (Gabon) also fits with this identification. As Idzi P. mentioned, I like to teach my students that nuclei flow-a flow-a to the tip inLoa loa -a fun learning aid!  Also check out thisbeautiful infographic by @cullen_lilley f...
Source: Creepy Dreadful Wonderful Parasites - June 26, 2022 Category: Parasitology Source Type: blogs