Wednesday, May 10, 2023

Case of the Week 717

 This week's classic case was generously provided by Florida Fan. The following was seen in a Giemsa-stained peripheral blood smear. No additional history is available. Diagnosis?

Each division on the ruler is 2.5 micrometers; the object is slightly less than 250 micrometers long. 


Anonymous said...

Beautifully stained sheath, and the last nucleus stands apart from the others. Make me think Brugia malayi?

Best regards,
Maarten Van Hemelen

Anonymous said...

Wuchereria bancrofti.

Anonymous said...

It is the Brugia malayi microfilaria because
it has loose sheath and smaller than W.bancrofti (>300) the most important the posterior end has two nuclei
Prof Lamia A.A.Galal

nema said...

Considering the size I would rather say Dipetalonema perstans. Very common parasite in Central Africa but considered non-pathogenic.

Idzi P. said...

Although that last nucleus does stand apart, I doubt this is Brugia. For Brugia, the distance between the other nuclei is not sufficient in my opinion. In regard of its thickness and the presence of a sheath, I'm quite sure it is not Dipetalonema/Mansonella either.
So... Although that last nucleus doesn't "flow" until the tip of the tail, I would not dare to rule out Loa loa for 100% - It could be that the last nucleus just didn't stain very well. I also seem to discern (right above the "7" on the ruler) something that might be a hernia...

I suspect the blood was taken during the night, as my definitive guess would go rather towards Wuchereria bancrofti: size, presence of a sheath, nuclei that don't reach the tip of the tail - it all seems to fit.
Clinical picture would be of help ;-)

Curious about the final diagnosis when Dr. Pritt provides us the answer.

Anonymous said...

I got to go with Brugia malayi: Size, sheath staining, tail, cephalic space, frequency of detection. Tail not perfect, but IMO better than Ll or Wb.
Of course: Would look at other critters on the slide, and chase down the clinician for more information before posting.