Clinical Vignette 10

 

Giemsa


H&E

 

           

 

 

 

 

Image 10:

A patient presents with depression, lethergy, intermittant imbalance increasing over the previous 10 months and a recent intermittant fever. He left the Congo as a refugee 22 months earlier. An LP revealed a CSF with many of these objects which stained differently with H&E and Giemsa.

Diagnosis:

African sleeping sickness caused by Trypanosoma brucei gambiense.  CSF IgG and IgM levels were sky high as was the CSF lymphocyte count. Trypanosoma were found in blood and CSF and the T. brucei PCR was positive in both.(at the NationalReference Centre for Parasitology [NRCP],  Montreal). Trypanosoma brucei serology by the CATT test was positive at the NRCP.   These "objects" are Morula cells of Mott, supposidly plasma cells crammed with IgM.

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