PHOTO QUIZ
crossm Photo Quiz: A Man with Fever and Headache Allen W. Bryan, Jr.,* Qinfang Qian,* James E. Kirby Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Citation Bryan AW, Jr, Qian Q, Kirby JE. 2017. Photo Quiz: A man with fever and headache. J Clin Microbiol 55:351. https://doi.org/ 10.1128/JCM.00193-15. Editor P. Bourbeau Copyright © 2017 American Society for Microbiology. All Rights Reserved. Address correspondence to James E. Kirby, [email protected].
* Present Address: Allen W. Bryan, Jr., Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Qinfang Qian, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA. For answer and discussion, see page 660 in this issue (https://doi.org/10.1128/JCM.00194-15).
FIG 1 Intracellular forms observed in Giemsa-stained peripheral blood smears (original magnification, ⫻1,000). Examples of red blood cells with four intracellular forms are indicated with darts.
A
54-year-old HIV-infected man developed fever, headache, diarrhea, and dry cough immediately following a 3-week trip to Haiti in late November 2014 and return to his home located in a wooded area in the Northeastern United States. On presentation to our clinic 2 weeks later, he described his diarrhea as mild, watery, and nonbloody (2 or 3 loose stools daily). His temperature was 101.6°F. His hematological indices were as follows (normal ranges are given in parentheses): white blood cell count, 13.5 ⫻ 103 cells/l (4 ⫻ 103 to 11 ⫻ 103 cells/l), with 85.8% neutrophils (50 to 70%), 9.4% lymphocytes (18 to 42%), 4.3% monocytes (2 to 11%), 0.2% eosinophils (0 to 4%), and 0.5% basophils (0 to 2%); red blood cell count, 4.12 ⫻ 106 cells/l (4.6 ⫻ 106 to 6.2 ⫻ 106 cells/l); hemoglobin, 13 g/dl (14 to 18 g/dl); hematocrit, 38.9% (40 to 52%); and platelets, 1.8 ⫻ 105/l (1.5 ⫻ 105 to 4.5 ⫻ 105/l). The patient’s HIV-1 viral load was 44,400 copies/ml, with a CD4⫹ cell count of 78 cells/l (490 to 1,740 cells/l). His peripheral blood smear showed intracellular forms (Giemsa stain) (Fig. 1) within 30% of red blood cells. The patient was treated with red blood cell exchange and antimicrobial agents (doxycycline-quinidine) appropriate for a suspected hematogenous infection. Three days after initiation of treatment, the infected cell count was reduced to 0.2%, and the patient was discharged home on antimicrobial medication.
February 2017 Volume 55 Issue 2
Journal of Clinical Microbiology
jcm.asm.org 351
crossm Photo Quiz: A Man with Fever and Headache Allen W. Bryan, Jr.,* Qinfang Qian,* James E. Kirby Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Citation Bryan AW, Jr, Qian Q, Kirby JE. 2017. Photo Quiz: A man with fever and headache. J Clin Microbiol 55:351. https://doi.org/ 10.1128/JCM.00193-15. Editor P. Bourbeau Copyright © 2017 American Society for Microbiology. All Rights Reserved. Address correspondence to James E. Kirby, [email protected].
* Present Address: Allen W. Bryan, Jr., Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Qinfang Qian, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA. For answer and discussion, see page 660 in this issue (https://doi.org/10.1128/JCM.00194-15).
FIG 1 Intracellular forms observed in Giemsa-stained peripheral blood smears (original magnification, ⫻1,000). Examples of red blood cells with four intracellular forms are indicated with darts.
A
54-year-old HIV-infected man developed fever, headache, diarrhea, and dry cough immediately following a 3-week trip to Haiti in late November 2014 and return to his home located in a wooded area in the Northeastern United States. On presentation to our clinic 2 weeks later, he described his diarrhea as mild, watery, and nonbloody (2 or 3 loose stools daily). His temperature was 101.6°F. His hematological indices were as follows (normal ranges are given in parentheses): white blood cell count, 13.5 ⫻ 103 cells/l (4 ⫻ 103 to 11 ⫻ 103 cells/l), with 85.8% neutrophils (50 to 70%), 9.4% lymphocytes (18 to 42%), 4.3% monocytes (2 to 11%), 0.2% eosinophils (0 to 4%), and 0.5% basophils (0 to 2%); red blood cell count, 4.12 ⫻ 106 cells/l (4.6 ⫻ 106 to 6.2 ⫻ 106 cells/l); hemoglobin, 13 g/dl (14 to 18 g/dl); hematocrit, 38.9% (40 to 52%); and platelets, 1.8 ⫻ 105/l (1.5 ⫻ 105 to 4.5 ⫻ 105/l). The patient’s HIV-1 viral load was 44,400 copies/ml, with a CD4⫹ cell count of 78 cells/l (490 to 1,740 cells/l). His peripheral blood smear showed intracellular forms (Giemsa stain) (Fig. 1) within 30% of red blood cells. The patient was treated with red blood cell exchange and antimicrobial agents (doxycycline-quinidine) appropriate for a suspected hematogenous infection. Three days after initiation of treatment, the infected cell count was reduced to 0.2%, and the patient was discharged home on antimicrobial medication.
February 2017 Volume 55 Issue 2
Journal of Clinical Microbiology
jcm.asm.org 351
