A mother brings her twelve-year-old male child to the pediatrician for his yearly physical examination. When questioned if there were any changes in sleep patterns, eating habits, etc. the mother only acknowledges that from time to time he complains of abdominal discomfort and periodic bouts of diarrhea. When the child is asked about the abdominal discomfort, he states that they are not painful. But, he mentions experiencing uncomfortable cramping. These cramps are many times preceded by diarrhea. He also remembers two times seeing unusual particles in his stool. He described them as flat and opaque. Sometimes they can be seen in segments, and sometimes singly. Additionally, the mother and the child admit that his energy level has been somewhat less than it used to be.
His physical examination is otherwise that of a normal twelve-year-old child.
A complete blood cell count test was ordered. A stool specimen was requested for collection for ova & parasite testing. It should be brought back in a two-vial collection kit. The kit consists of one vial of PVA and another vial of 10% formalin.
Both tests had significant test results. The complete blood cell count results of significance were as follows:
| Red blood cell count (rbc) | 3.8 m/uL |
| White blood cell count (wbc) | 3.0 b/L |
| Platelet count | 90,000 /mm |
| Hemoglobin (hb) | 9.5 g/dL |
| Hematocrit (hct) | 32% |
| Mean corpuscular volume (mcv) | 110 (fL) |
| WBC differential | Neutrophils are noted to be hyper-segmented – the differential count was normal limits |
| RBC morphology | Macrocytic red blood cells were noted |
The ova and parasite examination is significant for the following objects on high dry magnification.
The images above were photographed by W. Vientos.
The average size of the observed suspicious objects in the examination were 60-68um by 41-50um.
Can you answer the following questions about this case study?
- What is your diagnosis based on the CBC, ova & parasite, and clinical presentation?
- What are the main CBC results that give support for your diagnosis?
- The objects have some significant characteristics that point to an identification, what are they?
- What is the probable source of this infection?
- What is the treatment of choice of this infection?
- Where is this disease most prominently found in the world?
*Disclaimer: The information contained in this case study is to be used only as a case study example for teaching purposes. The information in the case study is both factual and fictional. Opinions formulated by the author are intended to stimulate discussion.