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?
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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!
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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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6 comments:
Beautifully stained sheath, and the last nucleus stands apart from the others. Make me think Brugia malayi?
Best regards,
Maarten Van Hemelen
Wuchereria bancrofti.
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
Considering the size I would rather say Dipetalonema perstans. Very common parasite in Central Africa but considered non-pathogenic.
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...
However...
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.
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.
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