looks like amastigotes

Seray Ozensoy ozensoy at med.ege.edu.tr
Sun Apr 18 10:00:10 BRT 1999

Dear all;
Excuse me for the late answer

>>I agree with Dr.Pablo. We don't knwow anything else about the suggestions
that were done. Looking again the photo I remembered a case of disseminated
sporothricosis on an HIV patient. It may be a strong possibility. Are there
any cutaneous lesions?

Yes there are eritamatous cutaneous lesions, and also pain and edema at
joints. I asked for histoplasmosis and later for sporotrichosis to the
mycolojists and they answered as no.

>>>Does the organism seen in the smear, stain with silver (Grocott,
Silver-methenamine ...)

Yes it was stained with GMS and the mycologists saw the organism but could
not find any similarity with the known funguies.
>>Patient clinical data and HIV serology

Hepatosplenomegaly, Hb: 10.8, Trombocytes: 100000, Leucocytes: 22000,fever:
37.3-38.9, pain and edema at joints, cutaneous erythamatous lesions

>>Bone marrow culture results for Leishmania/Trypanosome (NNN and Sneider),

Culture, serology and bone marrow smear were negative for Leishmania
fungal culture was also negative

>>Commercially availlable monoclonal antibodies can be used for
inmunoflurescent staining in orther to rule-out Toxoplasma gondii.

It was not look like Toxoplasma. We are experienced and know T.gondii.
Furthermore if we check pictures again, we will see organism has a capsule
or capsule like membrane. There were some organisms in and some out of
capsules. It is a little bit flue and others evaluate this as ghost of
erithrocytes. But we think those structures were not ghost of erythrocytes

They made a new bonemarrow biopsy and aspiration after seeing this organism
for culturing for the fungui and Leishmania
Cultures were negative. I could not see the organism at the second
bonemarrow smears (I checked about 5 smears), but the mycologists saw the
same organism again. I am thinking that it was a contamination from outside,
it was stained in a different lab.

One of my friends went to Prag last week and he checked the slide with a
parasitologist from Prag. She also showed him another slide from an Indian
patient which including the same organism and she also does not know the
organism. Also Dr. Yoshitsugu Matsumoto from Japan visited our lab few weeks
ago and he thought that it was a contamination from outside.

Now we are waiting for the mycologists decision.

Seray Ozensoy-Metin Korkmaz

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