Monday, April 2, 2018

Case of the Week 488

Happy April! It's time for our first case of the month by Idzi Potters and the Institute of Tropical Medicine, Antwerp.

The patient is an adult male without known travel history who passed the following worm-like structure. It was placed in physiological saline solution and sent to the laboratory for identification.



In the lab, a drop of the saline solution is also examined microscopically, revealing the structure in the picture (size: 32 µm).


Diagnosis please?

13 comments:

Adolfo said...

By the size it seems Taenia solium. The eggs are indistinguishable of the T. saginata

Blaine Mathison said...

The form of the proglottids and the presence of a single, lateral genital pore suggests Taenia. The egg is odd; it's clearly the oncosphere of a cyclophyllidean cestode but it's missing the striated outer shell characteristic of Taenia (perhaps it is just immature if liberated from a proglottid; the proglottids themselves are clearly not mature). Species-level ID not possible from these images.

M.C. Martín R. Hernández C. said...

Taenia sp

Anonymous said...

I concur with Blaine Mathison, we certainly see the hooklets in the egg but the outer shell is missing. The pictures did not show the median genital pores of D. latum, the proglottids are not typical of the other tape worms except those of Toenia sp.
Florida Fan

William Sears said...

There appears to be tapeworm egg that is most similar to hymenolepis nana. However, the worm itself seems to be larger than expected for h nana although no scale is provided in the picture. This may be a coinfection by taenia sp (if the provided section of worm is from the proximal part) and h nana.

Anonymous said...

Agree with Blaine Mathison. But cannot we identify this as T.saginata or T.asiatica because of the irregularly alterned genital pores ?

BA

Anonymous said...

Hymenolepis diminuta

Florence

Anonymous said...

On second look, the proglottids seem wider than long. This may indicate that they are craspedote or overlap. Without a central line of genital pores, this helps us eliminate Diphyllobothrium. The internal structures are not visible. The size of the ova is more consistent with that of H. nana.
Florida Fan

Idzi P. said...

Hello everybody!
Interesting discussion!
In reply to dr. Sear’s comment on size: my apologies for the lack of a scale bar... the structure was placed in a petri-dish of 10 cm diameter. Hopefully this is helpful...
Kind regards!

Rasta Bob said...

Proglottids wide, small egg w/hooks - Dipylidium caninum without the egg sack
?

William Sears said...

Thanks Idzi for the size clarification.
The other possibility here would be a bertiella species; however, I can't make out a pyriform apparatus in the egg. Also, by estimating the length of the worm, it's too long to be B studeri for sure but also B mucronata (40cm). Also, if there is no travel history from the netherlands he would have to work in a zoo or have a very fun pet to get a monkey worm.

Ok, so here's my final answer and it's a leap. I only see the inner shell in the image. So, perhaps this has been H diminuta all along. The egg is normally 70micrometers but that is with the outer shell. This is just the inner shell and oncosphere in the image which could measure about 32micrometers. The size of the worm could be around 70cm with proglottids wider than they are long. So, my final answer is H diminuta with a cracked egg. Looking forward to the answer so I can start sleeping again...

Pupuk Buah Durian said...

I thought it was a spagethi

Omar Cerna D. said...
This comment has been removed by the author.