Monday, November 5, 2012

Case of the Week 231

A 40 year old woman retrieved a 'worm' from her nasal cavity and brought it to her primary care physician, who then submitted it to the laboratory for identification.  The following images show the specimen that was received (pressed between 2 glass slides). (CLICK ON IMAGES TO ENLARGE)

40 times original magnification, unstained

100 times original magnification, unstained

200 times original magnification, unstained

400 times original magnification, unstained 

400 times original magnification, unstained

400 times original magnification, unstained

Identification?  How would you sign this case out?


Lukus Roberts said...

Im not sure what it is but my feeling is that it isnt helminth. The material looks like its shattered and composed of material which looks more insect than anything else to me. given the 4th picture shown, I would err towards some sort of louse as the thing that looks curved reminds me of a louse leg. I have no idea what the long strands are with the 'barbs' or perhaps tarsi, not what the collection of them are on the last picture as this doesnt fit in my mind with that of a head or public louse, but thier structure, made up of segmened units reminds me of some insect antennae.

thats all I got this time!

Anonymous said...

I do agree with Lukus. The specimen is consistent with insects' body parts. This seems like a "flown in" case. (Has anyone had a mosquito accidentally flown into the ear? It happened a few times to me). My result would read:"Specimen consistent with insects' body parts, unable to further identify. Please call the lab if definite identification is clinically relevant".

Florida fan

Lukus Roberts said...

As a bit of added interest, although I don't think this specimen is that of a helminth, I did some research on worm parasites of the nose anyway. The most interesting thing I found out that I didnt already know is that Enterobius verminicularis has previously (though rarely) been reported to infect the nasal cavities! In addition to the conjuctiva, vagina and ear as well. Familiar, yes, but no less fascinating for it. it would seem.

a case report of E. verminicularis infection in the nose of an 11 year old girl who tested negative for enteric infection is referenced below.

Kaniur, V., et al. 2005. Enterobius verminicularis in the nose: A rare entity. Indian journal of Otolaryngology and head and neck surgery. 57 (2): 148-150.

Anonymous said...

I am thinking insect parts as best google powers are not helping me..looking forward to seeing what this was! Thanks Lee

ParasiteGal said...

Tis is in responce to Luke Robert's comment - I also saw a very unusual case of a Pinworm case involving the nose, lacrimal duct, and eye of a 14 year old girl. We published the case in the journal of Clinical Microbiology last year. I'd be happy to provide a copy if anyone is interested!

J Clin Microbiol. 2011 December; 49(12): 4369–4370.
doi: 10.1128/JCM.05475-11
PMCID: PMC3233009
Enterobius vermicularis in a 14-Year-Old Girl's Eye

N. Esther Babady, Erich Awender, Robert Geller, Terry Miller, Gayle Scheetz, Heather Arguello, Scott A. Weisenberg, and Bobbi Pritt

Salbrent said...

I would send images to entomologists, CDC, my parasite buddies and psot on in the attempt to ID it as closely as possible.
If not report arthropod parts seen unable to fully ID and call the submitter

Anonymous said...

Arthropod parts identified.
No definitive evidence of human parasite. No helminth identified.

Unknown said...

I've never heard about Enterobius vermicularis infecting other tissues, that's really amazing! Thanks a lot for those articles!

MicrobeMan said...

Dr. Pritt - I'll take a copy. Thanks!

- Ryan