Monday, November 12, 2018

Case of the Week 518

This week's case is a bit of a puzzle for you to put together. The following object was seen in a urine sediment. It was initially moving, but very quickly died. It measures approximately 130 micrometers in length.
Wet prep, 10x objective
 Wet prep, 40x objective

Identification? Images are by one of our Clinical Microbiology fellows, Dr. Sarah Jung.


Bernardino Rocha said...

It´s clearly a Miracidium from Schistosoma haematobium, since the eggs are released from the urinary tract, and they hatch realy fast (15-30min). Another evidence is the hatched egg, near the miracidium, with the distinctive terminal spine. Great Blog by the way.

Idzi P. said...

I agree with Bernardino Rocha: Miracidium and egg shell fragments of Schistosoma haematobium. The shell fragments show the characteristic fine terminal spine. Very nice picture, showing miracidium and egg shell left-overs together!

Anonymous said...

How often can we see the newly hatched miracidium from a Schistosoma egg? Not in my working life so far. This one is typical of S. haematobium. Very nice finding and thanks for sharing.
Florida Fan

Brenda Waters said...

It looks as though there are crystals there, as well. Are there any crystals that are specifically associated with S. haematobium infection?
Bw in Vt

Unknown said...

Concur with Bernardino: a newborn (Schistosoma haematobium)with egg shell remnants.

Bernardino Rocha said...

Brenda Waters: The crystals found in this urine specimen are of no clinical relevace, you can identify uric acid crystals and plates, (crystalline uric acid~ forms at low pH 5 to 5,5, important, if very abundant, in urate nephropathy of gout) and triple phosphate crystals (the most abuntant and prism-like). hematuria is the most relevant finding in this case, you can see several red cells (small circular shaped in the picture) and some leucocytes.

Pablo Jimenez said...

How can we distinguish S. haematobium, from S. mansoni and S. japonicum, just by looking at the miracidium.

Blaine A. Mathison said...

Humpty Haematobium sat on a wall
Humpty Haematobium had good fall
All the King's horses
and all the King's men
Couldn't put Humpty Haematobium back together again!

Old One said...

My first experience with flukes happened many years ago while on a camping trip with mom and dad. I and several companions discovered a sunken rice boat (small boat used to harvest wild rice). We floated it and spent the morning pulling it through the water back to camp. As with all stupid boys we decided to air dry instead of using a beech towel. The next day we all were covered with a rash and thousands of blisters. An itch so intense you would sell your soul and throw in your first born just for relief. Mom said it was infected snails. How right she was. The culprits were cercaria from snails acting as secondary host for avian schistosomes.

Swarms of avian Schistosomal cercaria had penetrated our skin and were killed by an acute immune reaction.
Swimmer's itch, Schistosomal dermatitis.

A note to Florida Fan. Our lab never diagnosed human Schisto We would see them only as prepared specimens. If you're interested in seeing Schisto eggs, try collecting duck feces. Keeping in mind that there are a number of genera and species found in avians, so egg shape and size will vary. But I bet you score some miracidia.

Anonymous said...

Old One,
First my heart felt thanks to you. Second, I hope you will not mind me calling you Old One. For us Asians, with age comes respect if not reference. I my self just reached 70 a few days ago but still love to work with worms and train the new techs.
I will go gather some ducks excreta at my in laws, hopefully we will have some training material.
Florida Fan

William Sears said...

Miracidium from a hatched schistasome egg that set out too long.

Old One said...

Florida Fan, thank you for calling me "Old One". The truth be told, I'm probably not the oldest one on this blog ,and the honor of the name really belongs to someone else. I've taken on the nam de plume of my deceased mentor, Dr. William Bemrick, who taught me much of what I know. Like you, I love to teach, unlike you I've been retired for number of years and have no opportunity to share my knowledge and experience. This probably explains why I'm so long winded on this blog. Anyway when you see "the Old One" tag, don't think of an individual but rather that long chain of knowledge passed from person to person. Being modified and hopefully improved at each step. It's an honor to use all.

Anonymous said...

Old One,
Thank you for the wisdom. I admit, I had a misspelling, I meant " With age comes reverence". Anyway, English is my second foreign language.
Florida Fan

Salwa Dahesh said...