Presentation
A 62-year-old woman presented to the Mayo Clinic with intermittent high-grade fevers and malaise. She had returned from a wildlife safari in Kenya and Tanzania 4 weeks earlier and recalled a painful insect bite on her left foot that had since resolved. She had been empirically treated with quinine and multiple antibiotics (levofloxacin, azithromycin, metronidazole, doxycycline and vancomycin) without improvement. Peripheral smears were reviewed—extracellular organisms with an undulating membrane and posterior kinetoplast were observed. Cerebrospinal fluid showed an elevated white blood cell count (164 cells/μL) and elevated protein (191 mg/dL).
This case study is in collaboration with Bobbi Pritt, M.D., M.S., Mayo Clinic, and her blog, “."
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Author Information
Elsha Eggnink, M.D., AP/CP Pathology Resident, Mayo Clinic.
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