Answer: Not a parasite. Most closely resembles pollen.
I included this case since the object in some of the photos resembles a helminth egg (Toxocara canis or Capillaria spp. comes to mind). The key to recognizing that this is not an egg is in the last photograph which clearly shows the pores in the thick outer layer and triangular shape of the inner structures. There are no human parasites that have eggs in this configuration.
The following were seen in a concentrated wet preparation of stool. No history is available. Identification?
40X objective
Answer: As stated by cmassey, “Toxoplasma gondii. Criteria: rupturing cyst with what appear to be escaping tachyzoites. Morphology is crescent shape with a large nucleus and they appear to fit in the 4-8um by 2-3um size given in diagnostic literature.”
Great job to everyone who wrote in! This case demonstrates a few nice features of T. gondii. First, there are both cyst and free tachyzoite forms as seen here:
The following brain touch-preparations were stained with giemsa and viewed with a oil immersion objective. Diagnosis?
100X oil
Answer: Whipworm, Trichuris trichiura
Congratulations to everyone who wrote in! You all recognized the long slender head and larger body which gives this worm it’s name ‘whipworm’. In this case, the worm was immediately recognizable, and the expression of eggs provided confirmatory identification.
There are many other instances, however, when what is received in the clinical parasitology lab is not clearly a worm. This is when the identification of eggs is extremely useful. This is done by the following method:
Wearing gloves, the worm is gently ‘prodded’ with a blunt object, such as a sterile wooden applicator stick, to attempt to express eggs from its uterus. It is helpful to have the worm in a small amount of saline or formalin, so that this fluid can then be pipetted onto a slide for examination. Similarly, if the worm is received in fluid, it can be centrifuged briefly, and the supernatant removed, leaving the pelleted material behind. This material may also contain eggs to aid in the identification.
While I don’t usually write about my personal health, I was recently asked about health care reform during a discussion at the American Pathology Foundation meeting recently in Las Vegas. While the discussion centered on the main issue – not a full reform of the current healthcare system but rather insurance reform, it prompted me to put to words a few personal experiences and ask the question “What is the real cost of healthcare?”
In May of last year I came down with what I thought was a community acquired pneumonia. This was about the time of the first reported cases of H1N1 and out of fear of quarantine at the time for what I was sure was not H1N1 I avoided doctors and hospitals. After trying a couple courses of antibiotics prescribed by a colleague, without relief, I found myself at an “express care” facility on a weekend morning desperate for relief from my symptoms of fever, cough and chest pain.
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