Monday, April 8, 2019

Case of the Week 539

This week's beautiful case was donated by Florida Fan - a finding in a concentrated stool specimen:
The scale bars each represent 2.5 micrometers.


MayoMedStudent said...

Taenia spp. (solium/saginata)?

Bernardino Rocha said...

A beautifull photo of Hymenolepis nana with the characteristic thin egg shell, six-hooked oncosphere, and the polar filaments that rest between the oncosphere and egg shell.

Marta MP said...

Hymenolepis nana

Idzi P. said...

Egg of Hymenolepis nana - the dwarf tapeworm! Nice photograph Florida Fan!
Which staining is that?

My students often call this egg “Hymenolepsis” nana!
Once, WHO even published an overview of helminth eggs with the same typo!

Anonymous said...

Idzi: It's only 100mg% eosin in 0.85% saline. We got beautiful results with oocysts of Cryptosporidium spp. They look like tiny Granny Smith'apple with a bitten off side against a pink background. Once I was told that it came from Dr. Pritt's lab but as time goes by, I frankly do not remember.
Best wishes,
Florida Fan

ParasiteGal said...

I believe you're correct Florida Fan. We used to use eosin saline to make our direct wet preps of fresh stool. Alas, we stopped using this method when we discontinued accepting fresh stool. Now we just look at stool in the fixative in which it is received (Ecofix) for our concentrates. The color is quite beautiful.

Old One said...

Agree with H. nana.

To MayoMed Student: Brava (Bravo) To identify to the level of tapeworm, this would get you to a place where you might just be able to treat.

Taeniadae , the Taenia family contain a number of species, in humans we see the adult Taenia spp. you mentioned. All Taeniid eggs are indistinguishable. But you can easily ID a Taenia egg to genus. There have a 6 hooked (hexocanth) larvae ( make a note that these hooks are not hooks of the adult scolex).The outer shell is thick and made up of radial striations (corona radiata) which often breaks up the ambient light into it's spectral components. Check out Taenia egg images in Google. The eggs are roughly spherical, 30-35 Microns in size. Distinguishing the various spp. of Taenia can be done with mature segment morphology and size /shape of scolex hooks (or no hooks at all as in T. saginata). The adult of the 2 Taenia species have different pathological potential.

Dad liked to tell me what he called "Pearls of Wisdom". Guide posts for staying out of trouble. Here is one for you.

A British military Doctor identified a tapeworm egg from a local citizen in India. He was called to task by his irate patient who happened to be a member of the high Brahman caste. The Dr. had identified the infection to be T. saginata (beef tapeworm) to a Hindu priest, were as you know cattle are sacred.

Best of luck with your future service.

Anonymous said...

Also according to Hymenolepis nana egg.
What a fantastic picture! What interesting stories we can see on the blog!
By the way, Idzi, almost all my students also say "Hymenolepsis" and sometimes I answer them: What Egyptian dynasty? ;-)
Best wishes

Sir Galahad said...

Embrionoforo di Hymenolepis nana ( le uova di H.diminuta sono piĆ¹ grandi).

MayoMedStudent said...

To Old One:

Thank you for your nice explanation! I especially enjoyed the Pearl of Wisdom :P

I must confess that I have not yet heard of Hymenolepsis spp. - I definitely have a lot to learn!

MayoMedStudent said...

Oops *Hymenolepis

ParasiteGal said...

Agree with Old One - kudos to MayoMedStudent for giving this one a shot! This is a tapeworm that I don't teach you about, but it's relatively common, so I'm glad that you got to see it! Patients are usually asymptomatic and therefore most don't know that they are infected.

Anonymous said...

Dr. Pritt,
We routinely use Iodine stain to read the concentrates and whenever we find suspicious objects looking like Cryptosporidium oocysts, we make an Eosin smear to ease the distinction from non Cryptosporidium objects, especially the baby Blastocystis spp.
The trick works quite well. My team members usually say s... stains, Cryptos don't, Cryptos roll, s... don't. Your old trick still is very useful. Thanks.
Florida Fan

Old One said...

To ParasiteGal

Another reason not to accept fresh feces.

Back in the day my boss made arrangements to study Giardia and coccidian infections in western cattle herds. Samples were collected by local veterinarians and sent to our lab. Large animal vets are very practical, they would collect the
rectal specimen in an exam glove, invert the glove, tie it off, and label. I received hundreds of specimens in this fashion.

One day my boss received a call from the local post office saying that they had a problem with a box addressed to us and we should come directly. When I arrived the postal clerk was very gracious. They had taken my package outside and were quite happy that I came to take it away.

The package appeared to be gas tight, but the smell of fermented bovine feces seemed to saturate the air for yards. The package was a tape sealed box, and the internal gases had deformed its shape into a sphere (Florida Fan in this case s… could and did roll). One could almost see the box vibrate from its intense internal pressures. I’m sure the postal authorities thought it was an explosive hazaed.

Once back in the lab I took a blade to the box to unpack the specimens.

It’s at this point as I released the gas my recollections became hazy and probably should be taken with a grain of salt.

With the release of bovine tainted methane I can recall only two things. That night there was a spectacular show of aurora, both borealis and australis lighting the night skies for all to see. Second global warming progressed to the point where a berg the size of Texas broke off the Ross ice shelf and headed toward Terra del Fuego.

Blaine A. Mathison said...

I have nothing further to add, but I should note when I first came to ARUP, everyone here made the same pronunciation mistake of 'Hymenolepsis' instead of the correct 'Hymenolepis'. Not sure where this mistake came from or why multiple agencies have made this mistake.

Recycling and old one:

There once was a kid from Indiana
Who with his oatmeal did like banana
But with his food he did eat
A most wonderful treat
The cestode known as Hymenolepis nana

Old One said...

Just to be serious for a change.

Our veterinary parasitology lab received the majority of specimens fresh. Helminth eggs, ectoparasites, coccidia, and Giardia would all be handled without staining. We also would use a combination Giardia/Crypo IFA test and were fortunate not to have to deal with many other protozoans, but stains were available if needed. With adult flatworms we would stain and mount them if gross morphology were inadequate for id. Nematodes would be cleared with lactophenol making internal structures visible and open to microscopic measurements (could be helpful to examine and measure Toxocara spicules).

ParasiteGal said...

I love the stories, as always! Old One - wow, that was brave of you to open that package! In addition to the aurora borealis, did you get any good parasites out of it? :)

Florida Fan, perhaps we should bring back the eosin. I miss seeing the apple green oocysts of Cryptosporidium. We'll have to experiment with how it would work with our Ecofix fixative.

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