Question 1 pls ! CASE 43 ) The patient was a 58-year-old male with a 3-month his
ID: 215359 • Letter: Q
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Question 1 pls !CASE 43 ) The patient was a 58-year-old male with a 3-month history of a nonhealing ulcer on his right thigh. It began as a pimple and progressed. He had no constitutional symptoms and no response to oral or topical antibacterials (agents not specified in the history). He had no lesions elsewhere, nor did he have trauma at the site of inoculation. His prior travel history was significant for his having returned from the Amazon rain forest region of Peru 2 weeks prior to the onset of symptomš. In Peru, he stayed in an open-sided hut that did not have screens or windows. He had countless insect bites and had no pretravel immunizations, nor did he take malaria prophylaxis. In the United States, he lived in a rural commu- nity with three cats and one dog. Physical examination was essentially unremark- able, including normal vital signs, except for the lesion on his right thigh (Fig. 43.1). It was described as a superficial ulcer surrounded by a large area of erythem- atous indurated plaques. The lesion was nontender, nonpurulent, and without discharge. He had a normal complete blood count, electrolytes, and liver function tests. He was referred to the dermatology department, where a punch biopsy was performed (Fig. 43.2) 1. What was the organism causing his infection? Based on geography, you should be able to name the genus and species. 24 MacE
Explanation / Answer
1) The organism can be idendified as Leishmania mexicana. The organism is infecteds to the humans by the bit of sand flies in the mountain and forest areas.
2) The organism in the slide is in Promastigote stage . The organism will be in Amastigote stage in human infection.
Amastigotes multiply and spread the infection in humans and promastigotes mutiply and spread infection in sand flies. Punch biopsy was taken from the raised edje of the leison because there will be more organism load and hence easy to identify .
3)open sour ulcer, wide spread skin leisons and markedly enlarged speen .
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