Case #374 - July 2014
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A 34-year-old missionary worker sought medical attention for abdominal pain, nausea, and watery diarrhea after returning from visiting friends in Central America. A stool specimen was collected for laboratory testing and a modified Kinyoun’s acid-fast stained smear was prepared. An aliquot of the stool, along with the acid-fast stained smear, was sent to the CDC-DPDx laboratory for confirmatory testing. Figures A and B show what was observed in moderate numbers on the acid-fast stained smear at 500x magnification with oil. Figures C-F were taken at 400x magnification from a wet mount of the stool specimen. Figures C and E were taken using bright-field microscopy; Figures D and F represent the same fields, respectively, viewed using ultraviolet (UV) microscopy. The objects of interest measured 8-9 micrometers in diameter on average. What is your diagnosis? Based on what criteria?
Figure A
Figure B
Figure C
Figure D
Figure E
Case Answer
This was a case of cyclosporiasis caused by Cyclospora cayetanensis. Diagnostic features included:
- round, refractile non-sporulated oocysts within the size range for Cyclospora (Figures C and E).
- oocysts whose wall autofluoresce when viewed with UV microscopy (Figures D and F).
- variable acid-fast staining oocysts (Figure A).
More on: cyclosporiasis
Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
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