A 78-year-old female is brought to your office for examination by her son. The son just recently returned from the State of Madhya Pradesh in India where he picked up his mother to bring back to the United States after the unfortunate loss of most of her immediate family in a tragic fire.
She does not report any chief complaints other than a small chronic infection on her leg. The patient appeared healthy and alert with a normal general physical and systemic examination except for the small festering wound infection to her right leg that she had complained about. The wound did not appear to be overtly erythematous or have any purulent exudate expressed, but nevertheless it was slightly open and slightly inflamed. Of note was a visually noticeable enlargement of her right leg in comparison to her left leg.
The patient was afebrile and did not have any recollection of any intermittent fevers and chills. The wound had a clean margin of tissue collected for gram stain and culture. Blood work was ordered that included BUN, Creatinine, electrolytes, and a complete blood cell count.
The chemistry results are as follows:
| Chemistry Analyte | Patient Result |
| BUN | 15 mg/dL |
| Creatine | 1.0 mg/dL |
| CO2 | 25 mEq/L |
| Potassium | 4 mEq/L |
| Na | 135 mEq/L |
| Chloride | 98 mEq/L |
| Glucose | 133 mg/dL |
The results of the complete blood cell count and differential are as follows:
| Blood Analyte | Patient Result |
| Total WBC | 4,500 (10³/uL) |
| Total RBC | 2.66 (10⁶/uL) |
| Hglb | 8 g/dL |
| Hct | 25.6% |
| MCV | 96.2 (fl) |
| MCHC | 32 (g/dL) |
| Neutrophils | 6.5 (10³/uL) |
| Lymphocytes | .80 (10³/uL) |
| Monocytes | .78 (10³/uL) |
| Basophils | .01 (10³/uL) |
| Eosinophils | 2.0 (10³/uL) |
The differential was significant for elevated eosinophilic white blood cells. It was also significant for the following forms which measured between 175-230 um (see images below).
approximately 175-230 um (photo by W. Vientos)
approximately 175-230 um (photo by W. Vientos)
See if you can answer the following questions given the previous information:
Given the patient’s history, clinical presentation, and significant complete blood count and differential results, what is this patient’s most likely diagnosis?
From the morphology, what organism (genus and species) is this identified as?
What other organisms belong to the same group as this organism?
What disease manifestation is this organism most known for?
What is the vector of this organism and where is this organism geographically endemic?
What treatment options are available for infections with this organism?
What complications can arise due to chronic and acute infections with this organism?
*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.