PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jcmPermissionsJournals.ASM.orgJournalJCM ArticleJournal InfoAuthorsReviewers
 
J Clin Microbiol. 2017 February; 55(2): 351.
Published online 2017 January 25. doi:  10.1128/JCM.00193-15
PMCID: PMC5277501

Photo Quiz: A Man with Fever and Headache

P. Bourbeau, Editor

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/μl (4 × 103 to 11 × 103 cells/μl), 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/μl (4.6 × 106 to 6.2 × 106 cells/μl); hemoglobin, 13 g/dl (14 to 18 g/dl); hematocrit, 38.9% (40 to 52%); and platelets, 1.8 × 105/μl (1.5 × 105 to 4.5 × 105/μl). The patient's HIV-1 viral load was 44,400 copies/ml, with a CD4+ cell count of 78 cells/μl (490 to 1,740 cells/μl). 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.

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.

For answer and discussion, see page 660 in this issue (https://doi.org/10.1128/JCM.00194-15).


Articles from Journal of Clinical Microbiology are provided here courtesy of American Society for Microbiology (ASM)