2013 DPDx Case Studies

A 27-year-old man in the U.S. Army, who had been stationed overseas in southeast Asia, sought medical attention for nausea, vomiting, and intermittent diarrhea.

A 29-year-old female post-graduate student in Zoology went on an expedition to see the lowland gorillas in the Democratic Republic of Congo. She reported numerous insect bites while traveling but did take anti-malarial prophylaxis.

A 19-year-old female presented to the emergency room with fever, chills, and nausea on a 48-hour cycle. She had travel history to the Bahamas and Tanzania, but has not been abroad for nearly nine months.

A county health department in Kansas routinely collects stool specimens as part of their refugee screening program. Stool is collected in 10% formalin and zinc-PVA (Zn-PVA) and forwarded to the state health laboratory for ova-and-parasite (O&P) examination.

A 59-year-old man required emergency medical attention due to hyperpyrexia (>40° C/104° F), generalized convulsions, and signs of renal failure. The patient's recent travel history was not available.

A 26-year-old female college student had undergone a homeopathic regimen advertised to eliminate parasites from the body. The only travel reported was to Maine a year ago to live with relatives on a farm between semesters.

A worm-like object was removed during a routine colonoscopy performed on a 65-year-old male patient. The patient had no gastrointestinal complaints and no documented international travel.

After returning from a weekend camping trip, a hunter from Massachusetts discovered a tick attached to his lower leg. He removed the tick and brought it to his local health department, who in turn forwarded the specimen to the State Entomologist for identification.

A 27-year-old man sought medical assistance for gastrointestinal symptoms that included watery diarrhea, abdominal pain, and fatigue. He reported no international travel within the last year.

A 54-year-old male from Pennsylvania presented to his health provider with fever, chills, malaise, and loss of appetite. The patient was originally from Mexico but has been living in the eastern U.S. for the past several months.

A nine-year-old child returned from summer camp in the mountains of North Carolina with complaints of abdominal pain, gas, and intermittent diarrhea. His parents took him to the family practitioner, who collected stool in Zn-PVA and 10% formalin for a routine ova-and-parasite (O&P) examination.

A 60-year-old Canadian presented to his health care provider with recurrent subcutaneous swellings in his posterior chest. The only travel outside of Canada reported in the last year was to Florida. Biopsy specimens were taken and sent to Pathology for routine histological work-up.

A 59-year-old foreign correspondent sought medical attention from his health care provider for intermittent hematuria which had started while on an assignment in Malawi. A urine specimen was collected, concentrated by centrifugation, and examined microscopically.

A 45-year-old man with travel history to Ghana presented to his health care provider with recurrent fever and chills. He admitted to not taking any kind of malaria prophylaxis during his travels.

Random night blood specimens were collected from over 500 subjects in an area endemic for lymphatic filariasis in coastal India. Roughly one-third of the cases were symptomatic, with or without recurrent episodes of fever and various degrees of lymphedema.

A 24-year-old refugee from Thailand was being treated for tuberculosis by a local health department. Sputum specimens were collected at regular intervals to monitor the treatment progress.

An 83-year-old man presented to a medical institution with shortness of breath and left flank pain that developed during a trip to Mexico shortly beforehand. Magnetic resolution imaging (MRI) revealed an exophytic mass on his left kidney.

A 21-year-old exchange student from Nepal sought medical attention for intermittent diarrhea associated with mild abdominal cramps. A stool specimen was collected for laboratory testing in low viscosity polyvinyl alcohol (LV-PVA).

Stool specimens were collected from residents of the Peruvian Amazon rain forest to evaluate the burden of helminth infections. Stool was collected and processed via Kato Katz at a laboratory in Cusco, Peru.

A 26-year-old female presented at a local hospital with severe pain and bloody discharge from the ear. The symptoms started while on a returning flight from vacation in Central America. The patient explained that while on vacation she visited a local physician to have a fly removed from her ear canal.

A 58-year-old man sought medical attention for numerous nodules on the right upper arm and forearm. He had recently relapsed with lymphocytic leukemia. Two weeks prior to the presentation of the nodules he was diagnosed with pneumonia and was also being treated for Clostridium difficile colitis.

A 24-year-old man sought medical attention from his health care provider for intermittent abdominal cramping and mild diarrhea. A stool specimen was collected in 10% formalin for laboratory testing.

The CDC conducted a survey with the Ministry of Health in Uganda to evaluate the prevalence of filariasis among the local population. Skin snips and blood specimens were collected and sent to a regional laboratory for preparation.

The DPDx Team received a pair of proglottids from a state health lab for cestode confirmation and identification. The specimens were submitted in 70% ethanol and measured on average 12.0 mm long by 3.0 mm wide.