Parasitology Plate Rounds Day 2: Cestodes, Nematodes, and Miscellany

CASES
Note: Images are from cdc.gov/dpdx unless otherwise noted.

1. An 8 year old boy presents with fatigue and is diagnosed with iron deficiency anemia. He lives in a
home without indoor plumbing and in the warm summer months plays outside without shoes on. He
receives an anti-parasitic treatment and the organism on your microscope is found in his filtered post-
treatment stool.

Microscope:

Questions:

a. What is this?
b. How did the child become infected?
 2. A 23 year old woman returns from a two week spring break in northeast Brazil with a serpiginous rash
on her right posterior upper leg. She spent every day laying on the sunny, sandy beaches. She is very
concerned because the rash seems to be moving. The adult parasite is on your microscope.

The rash:

(Image source: ADV SKIN WOUND CARE 2020;33:356–9.)

Microscope:

Questions:

a. What syndrome does this woman have?

b. How was she likely infected?
c. Would you find the adult parasite or eggs in this woman?
 3. A 76 year old woman with autoimmune thrombocytopenia was started on high dose dexamethasone,
and subsequently presented with fever, shortness of breath, and abdominal pain. Imaging of her lungs
showed bilateral pulmonary infiltrates and pulmonary edema. Of note, she had lived in NYC for 60
years after emigrating from Jamaica. A slide of the bronchoalveolar lavage fluid is on the computer
screen (static).

Microscope:

Questions:

a. What is this?
b. How was she originally infected with it?
c. What were this patient’s risk factors?
d. What are the elements in her history that point to this diagnosis?
 4. A 37 yo woman presents to her primary physician with fatigue. Routine blood work shows a macrocytic
anemia with B12 deficiency. Upon further questioning, she reports that she lived in Chile. After a stool
ova and parasite examination, she received one dose of praziquantel. She then passed something
startling in her stool. The image is on the microscope at your station.

Microscope:

The whole worm:

Questions:

a. What is this?
b. How was she infected?
c. Could she have had this since her time living in Chile?
 5. A 50 year old patient undergoes a routine screening colonoscopy as part of her health maintenance
program. She has no GI complaints. She has no polyps, but does have a finding that can be seen in
the video on your computer screen.

Check out this video!

https://ars.els-cdn.com/content/image/1-s2.0-S0016510708001028-mmc1.mov

Here is a still image from the video:

Image source: Gastrointest Endosc. 2008 Aug;68(2):376-7

Questions:

a. What is this?
b. How else could this infection have been diagnosed?
c. Are you surprised that she didn’t have symptoms?
 6. A 22 year old man goes to his student health walk-in clinic with “hives.” He is worried that he had an
allergic reaction to a bug bite. He brings one for you to see.

Clinical image: N Engl J Med 2020;382:2230-7

Bugs: cdc.gov/dpdx

Questions:

a. What is this?
b. What diseases can this bug transmit?
7. Onchocerca volvulus. A 30 year old woman from rural Nigeria has a biopsy of a nodule on her left scalp.
The pathology slide from the biopsy is on your microscope.

Slide on microscope

Questions:
a. What is this?
b. How long can adult parasites live in skin nodules?
c. How is this parasite transmitted?
d. What is a severe complication of this infection?
 8. A father notices that his 3 year old son has severe pruritus around the anus. His pediatrician
recommends applying the adhesive site of clear tape to the area around the anus in the morning and
bringing the tape in for examination under a microscope. This is what is seen:

Link to the virtual microscope:

https://vm.med.cornell.edu/histopathology/Slides/ImageReadFrames.pl?SlidePath=2916

Questions:
a. How did the child become infected?
b. This infection is common in school- or preschool-aged children and in crowded conditions; why
might that be?
c. Can adult worms be detected during infection?
 9. A 48 yo woman who recently emigrated from Lebanon presented to the emergency room with right
upper quadrant abdominal pain. Evaluation included a CT scan of the abdomen which showed a large
cystic lesion in the liver. She underwent a percutaneous biopsy of the liver lesion and during the
procedure developed shortness of breath and hypotension with suspicion for anaphylaxis. The
pathology slide from the biopsy is on the computer microscope. A portion of the aspirate is on the
microscope.

Virtual microscope:
https://vm.med.cornell.edu/histopathology/Slides/ImageReadFrames.pl?SlidePath=2876

Questions:
a. What is this?
b. How would she have become infected?
c. What happened during the biopsy?
 10. A 6 yo boy in the highlands of Guatemala has no major medical problems. One morning, his
grandmother goes into his room to wake him up and finds something moving on his pillow. They bring
it to you in a cup.

Questions:
a. What is this?
b. How did it get on his pillow?
c. How did he get infected?
d. How could this infection have been diagnosed earlier?