Hematoxylin and eosin (H&E), 40x
H&E, 200x
H&E, 1000x
Jones Silver stain, 1000x (inset approximately 2000x)
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A parasitologist's view of the world
Welcome to Parasite Case of the Week
Every week I will post a new Case, along with the answer to the previous case. Please feel free to write in with your answers, comments, and questions. Also check out my image archive website at http://parasitewonders.com. Enjoy!
The Fine Print:
Please note that all opinions expressed here are mine and not my employer. Information provided is for educational purposes only. It is not intended as and does not substitute for medical advice. I do not accept medical consults from patients.
The Fine Print:
Please note that all opinions expressed here are mine and not my employer. Information provided is for educational purposes only. It is not intended as and does not substitute for medical advice. I do not accept medical consults from patients.
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11 comments:
Leishmaniasis
The morphology of the organism is compatible with amastigotes of Leishmania sp. The organisms did not pick up silver stain indicates they are not fungal in origin. The patient has HIV and this predisposes the patient to Leishmania infection.
Florida Fan
Leishmania is my first option too, but I would like to know how would you rule out Trypanosoma cruzi. Is it possible just on morphology? We had a recent case in the brain and the microbiologist diagnosed leishmania too with the citology material. It was Chagas.
My differential was microsporidia or Leishmania, however going on morphology alone my answer is a Leishmania infection due to the presence of a rod shaped Kinetoplast along side the nucleus in the amastigotes. The size (1um) is also consistent with this diagnosis.
Leishmaniasis, given the presence of the rod shaped kinetoplasts presen and the cell type infected. In order to distinguish Trypanosoma spp. from Leishmania, I was taught to look at the cell type in which the organisms are found. Leishmania is present in macrophages while Trypanosoma is present in somatic cells (cardiac tissue, for example). In this case, it looks like there are lymphoid aggregates present in the area of the organisms, likely supporting that they are contained within macrophages.
Visceral Leishmaniasis
That's interesting, thank you. Nonetheless, in the case I mentioned, they were seen both inside and outside macrophages. I admit it was a huge brain abscess in an Aids patient and probably in this scenario they would get into anything.
visceral leishmania
Intracellular nature of the organism, with a "dot" ie the nucleus and a "dash" ie. the axoneme kinetoplast. Leishmania sp.
LD bodies of Leishmania
My diagnosis is Chagas. The clinical history is important here (there also may be the size of amastigotes to differentiate Leishmania versus T.cruzi, and we should review that). But, visceral leishmaniasis or a visceralized tegumental leishmaniasis in a HIV patient, the strinking feature is bone marrow insufficiency and its three main findings: anemia, leucopenia and plaquetopenia. No one would go to kidney biopsy with plaquetopenia.
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