Sunday, October 23, 2016

Case of the Week 419

This week's case was generously donated by Dr. Steve Jenkins. The object below was seen in a wet prep of semen. Identification?

17 comments:

Yasir Alruwaili said...

Trichomonas vaginalis after romantic night?

Anthony Rochester said...

Yeah I would have thought Trichomonas as well

Anonymous said...

Yes, given the source of the specimen being semen, the identification of trichomonas vaginalis would be the choice. Just one thing, men can be infected too and the patient must have acquired the flagelate from one or more partners.

Florida Fan

Anonymous said...

Trichomonas vaginalis

Wan Hafiz

Muharib Alruwaili said...

According to type of specimen and this nice jerky movement, it is most likely to be Trichomams Vaginalis

Dario Campese said...

trichomonas vaginalis

Anonymous said...

If this is trichomonas, then it is one wild lookin’ trichomonas.

1. Trichomonas vaginalis doesn’t have that many “flagella.” This specimen has far too many “flagella”. Trich only has five total, four on one end, and one on the other. The four grouped flagella come out at a single point and not all over the place like this specimen.

2. Trich also as an undulating membrane, this video is hard to tell but it looks absent in this specimen.

3. Trich’s motility is all over the place, herky-jerky, this specimen seems to be flowing all in the same direction.

4. I wish a size was posted, but my hunch is that this is too large for a trich.

5. Trich is usually more rounded, or at least pear shaped. This specimen looks more elongated than a trich.

6. I have learned on Bobbie’s Blog that if it walks like duck, quacks like a duck, it just might be a zebra ;-)

My ID is ciliated epithelial cell (No parasite found). Or, a co-worker of mine said it kinda looks like an octopus, so maybe a new parasite Octomonas vaginalis?

Michigan Micro

Anonymous said...

Michigan Micro:
Your points make sense. On second look, it may not be Trichomonas after all. Let's see what Dr. Pritt is going to give us as the answer.
At least we can learn a few more interesting things.
"Errare humanum est".

Florida Fan

Anthony Rochester said...

Do ciliated epithelial cells move around like that when not attached? And where could it have come from?

Anonymous said...

@Anthony - Yes, as far as I know they will still "swim" around even when detached. And for a possible location... that is a good question. I don't know human anatomy well enough to say where ciliated cells are located. All I know is that this specimen would be a crazy looking Trich if that is the correct ID. Like Florida Fans says, we will have to wait and see what Dr. Pritt has to say.

Michigan Micro

CarolVA said...

Could it be Pthirus pubis?

Anthony Rochester said...

I searched youtube for ciliated epithelial cell and there were videos of these cells wiggling away like this, only faster. I reckon that's what it is. The main place in the body to find these would be the trachea, and as far as I know, not any part of the genital tract, male or female. I could be wrong though. Curious to see the answer..

Anthony Rochester said...

Hang on, the uterine/fallopian tubes have ciliated cells...

Yasir Alruwaili said...

Maybe it is just a Trichomonas wearing its octopus Halloween costume:)

It may be right that it does not look as the usual T. vaginalis but this wet prep looks so bubbly and that why it is not clear to determine if this is T. vaginalis or not especially with the lack of the patient history.
Epithelial cell is much bigger with a very obvious nucleus. If it is ciliated then the cilia should be all around the cell, here we see only a part of it has cilia.
Try to watch the video on Youtube but change the speed of the video from 1 to 0.25, a few cilia will be seen there but they move quite fast.

Anonymous said...

If you look at Case 369 from almost exactly a year ago it is the same thing. (I knew I saw this before). Case 369 was from a respiratory specimen - bronch lavage. So, much different site, but it looks very similar.

Michigan Micro

Anthony Rochester said...

Yasir, why should cilia be all around the cell? e.g. in the trachea, the epithelial cells are stuck to the basement membrane and to each other side by side, so only 1 side has the cilia to move mucus up and out.
As for size - a squamous epithelial cell would be bigger and flatter, but this isn't one of those, and we don't have any size reference.

Yasir Alruwaili said...

Anthony, I meant if this organism is a ciliated in general like a bacterium or another pathogen, we used to see cilia all around, flagella are usually on one side or two opposite sides.
This is a semen sample,(from a man,) so I don't think there will be any type of ciliated epithelial cell since they mostly found in respiratory or female reproductive system. The big question for me is if this is a Trichomonas, do we really need to do a semen analysis to detect it? Would not a urine sample be enough? Or is it just by accident?