Sunday, May 29, 2016

Case of the Week 398

We had a number of great arthropod cases in the past few weeks! Here's one that had us stumped for a little while:

The following live objects were noted on a tampon brought in by a female patient to her  gynecologist. The patient also reports that these objects are being shed in her stool and urine.

Examination of the specimen revealed a clearly-used tampon containing the following objects - many that appeared to be superficially embedded in the cotton fibers:







Identification? What additional information would you like?

10 comments:

Eagleville said...

Were there images?

Khalid Elfeel said...

Chrysoma- Screw- worm larvae - obligatory invasive myasis !!

Kathy Murray Leisure, MD said...

Old world screw worm larvae such as Chrysomya bezziana or facultative parasitic larvae of the family Syrphidae?

Kathy Murray Leisure, MD said...

Did the woman have an IUD or internal gynecology wounds or other sources of wound inflammation comprising a feeding source for these larvae?

Kathy Murray Leisure, MD said...

Alternatively, did she live with flea-infested dog(s) or cat(s)? If she accidentally ingested some of her pet's fleas, she may have acquired Dipylidium caninum tapeworm intestinal infection! Ich.

Anonymous said...

In trying to convince her health care provider she is infested with parasites, she chose this used tampon which had likely been in the trash outside for a few days and attracted flies. She herself is not shedding fly larvae.

Jon said...

It looks like there are a couple of different styles of pupae pictured, indicating multiple species. This makes me think delusory parasitosis rather than actual myiasis. Additionally, myiasis would be really obvious upon examination.

Chong Chin said...

Urogential myiasis by Diptera larvae (Perhaps in the Family Phoridae)

Anonymous said...

The presence of different larvae suggests that the tampon may have been exposed to outdoor conditions. The patient's complaints of shedding larvae in her feces and urine is another testimony to her very agitated mental status.
The case can be summarized as a very active delusional parasitosis.
There seems to be an increase in the number of these cases recently, though not all on the full moon. I would suggest a referral to psychiatric evaluation and follow up.

Florida Fan

Anonymous said...

Species identification with these images is difficult. At least some seem facultative Calliphorid larvae, although others are clearly different. Since they were externally on the tampon, they were probably not involved in true myiasis and the tampon had been exposed for some time, at least a couple of days if the largest are L2 or L3.