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Images of Memorable Cases: Case 63

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Case_63-pres1-1.jpg

Peripheral blood film from a woman with AIDS who had a two-day history of high fever and shaking chills.

63. Diplococci heralding bacteremia

Blood cultures in this patient grew Streptococcus pneumoniae.

The automated blood counters in widespread use today cannot detect pathogens in the peripheral blood film, but the human eye can. Discovering pathogens in the peripheral blood film enables the examiner to make a specific diagnosis on the spot—before results of blood cultures, serologic studies, or other tests become available. Moreover, it allows prompt administration of potentially life-saving therapy. And, as this patient exemplifies, it raises the possibility of an altered immune status, such as AIDS, acquired hyposplenism, hypogammaglobulinemia, or deficiency of certain components of the complement system.

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