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Charlie's physician suggested it might be a viral infection that just needed to "run its course." A
few months later, Charlie was blindsided by a severe headache, followed by a seizure. Additional
symptoms also developed--he started to experience memory deficits and disorientation. Charlie
took a leave of absence from his practice and a neurologist took over his case. New blood tests
were ordered, and although most of the tests showed nothing remarkable, a hematology
technologist noted small, dark-staining cells that appeared to be adherent to the red blood cells
(RBCs) in the Wright-Giemsa-stained peripheral blood smear (left image). An additional blood
sample was sent to the microbiology lab and stained with methylene blue to look for bacteria in the
blood (right image). Red blood cells range in diameter from 6 to 8m. Could the dark-staining
objects seen inside some of the RBCs (arrow) be bacteria? Choose the most likely explanation.
No, they are too large. No, they are too small and likely to be virus. Yes, they appear the correct
shape and structure. Yes, they have visible internal structures. It is not possible to tell from this
information.

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