This week's case was donated by Dr. Blake Cirks. The following object was passed per rectum by an otherwise asymptomatic individual living in Laos. Based on the image and video, what is the most likely diagnosis?
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Every week I will post a new Case, along with the answer to the previous case. Please feel free to write in with your answers, comments, and questions. Also check out my image archive website at http://parasitewonders.com. Enjoy!
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Please note that all opinions expressed here are mine and not my employer. Information provided is for educational purposes only. It is not intended as and does not substitute for medical advice. I do not accept medical consults from patients.
The Fine Print:
Please note that all opinions expressed here are mine and not my employer. Information provided is for educational purposes only. It is not intended as and does not substitute for medical advice. I do not accept medical consults from patients.
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8 comments:
Fasciolopsis buski adult?
looks like an intestinal fluke or may be proglottis?
Yes, general morphology favors an intestinal fluke as we cannot see the proglotids typical of tapeworms. Speaking of a fluke from Laos, I don’t see the romantic pairs of Schistosoma mekongi. Using the width of the two fingers say 12 mm each the length of the fluke would be about 25 mm, it seems to agree with Fasciolopsis buski. Too bad we cannot express the eggs nor do a dissection for definite identification.
Florida Fan
Motile gravid proglottide of Taenia saginata (proglottids up to 20x7mm) or maybe T.asiatica though they are not so long.
Size and typical way of movement are perfectly compatible with Taenia proglottids. This very active movement of mature, gravid, and freshly passed proglottids rules out Taenia solium (who's proglottids remain immobile when passed). This leaves us with T. saginata and T. suihominis (Mathison 2021 - syn. T. asiatica) as a possibility. Both of these species seem to be endemic in Lao PDR, so my final answer would be "Proglottid of Taenia saginata / Taenia suihominis".
Very nice video by the way!
Boy, how could I forget this thing that I had personal experience with when I was about five or six years old! It terrified this boy and he grabbed that bundle in a piece of newspaper and pulled it out, thank Goodness the entire mess came out including its scolex, the wiggling “pieces of flat noodles” never came back. The rounded corners of the living one misled me. The ones I had at work being stunned by ambient temperature or fixed in ethanol have more square corners. Just when you believe you know, you need to learn again.
Florida Fan
Given the appearance and mobility, I would also lean toward T. saginata, since Taenia solium is normally excreted passively in chains in the stool… We’ve received a few samples like that in the lab, and it fits! No experience with T. asiatica, though… Great video!
Perhaps Opisthorchis viverrini segment? Don't know...
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