Monday, August 10, 2020

Case of the Week 602

 This week's case was generously donated by Dr. Harsha Sheorey. The following object was submitted from a middle-aged man with hematuria. The specimen source is urine, and accompanying instructions asked the laboratory to rule out a fluke or cestode. The patient had traveled to Southeast Asia in the past.





Identification? What are the clinical implications for this patient?

8 comments:

Richard Pollack said...

Psychodidae (drain / sewer fly) larva. Not from patient but from commode. Upon their discovery, folks often jump to the conclusion that they derived from the bladder or intestine. There are reports in the literature of myiasis from these flies, but one should generally be skeptical. It isn't that unusual to have Psychodid flies and psychoses in the same patient, but one doesn't cause the other.

Unknown said...

Nicely done Richard Pollack! I was wondering what the heck a fly larva was doing in a urine sample.

Anonymous said...

Appears to be Clogmia albipunctata, a fly from the family Psychodidae, but that is preliminary. As Richard Pollack says, important to rule out this sample coming from a toilet! It is not impossible this was a case of urogenital myiasis.

Anonymous said...

Richard Pollack is right. Being not an entomologist, I would say latrine fly larva and leave the entomology part to those specialists. The specimen has all the anatomy parts of water insect larva including a breathing tube at the posterior. For sure this would be a startling finding but, to the layman it may create a stunning effect at least.
How many people have “delusional parasitosis”? I hope only a few as each of these cases does require a phone call to the physician who most of the time receives the report as being hilarious.
I love your last line Richard, the play on word is so well written.
Florida Fan

Old One said...

Being the only game in town opens you up to being a magnet for stuff people find in their toilets. This can be tough on your self worth but sometimes it can provide for some interesting finds. I certainly have identified a number of free ranging drain flies in my day, but I think this specimen could possibly be a case of actual urogenital myiasis.

A small number of documented cases of Psychodidae myiasis from North Africa, the Middle East and Asia are found in the literature. Most infestations are cause by members of the genus Psychoda that appears to be the genera of this specimen and certainly not a flatworm.

Accidental infestations occur under unsanitary conditions, as do pseudoinfestations. To confirm a true infestation, a proper medically supervised collection should take place. I don’t know if there is an effective treatment, but the flies will either pass or die in situ and not reproduce in the host.

Blaine A. Mathison said...

Anonymous Anonymous said...
Appears to be Clogmia albipunctata, a fly from the family Psychodidae, but that is preliminary. As Richard Pollack says, important to rule out this sample coming from a toilet! It is not impossible this was a case of urogenital myiasis.

Reply: It is impossible this was a cause of urogenital myiasis

Old One Said:

A small number of documented cases of Psychodidae myiasis from North Africa, the Middle East and Asia are found in the literature. Most infestations are cause by members of the genus Psychoda that appears to be the genera of this specimen and certainly not a flatworm.

Accidental infestations occur under unsanitary conditions, as do pseudoinfestations. To confirm a true infestation, a proper medically supervised collection should take place. I don’t know if there is an effective treatment, but the flies will either pass or die in situ and not reproduce in the host

Reply: These cases are all reports of incidental findings, as Richard Pollack eluded to. There are not even 'accidental infestations' of pyschidid larvae.

It is amazing what a bad care report or two can do, spread bad information in the literature like an infection. Much like those ridiculous case reports citing ciliocythophthoria as infection with Lophomonas blattarum (which, for what it is worth, does NOT cause human disease).

Octavia Johnson said...

Appears to be Urogenital myiasis

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