A man 26 years comes with headache, body ache, anxiety and suffering from pulmonary tuberculosis. This parasite was found in the urine. What is the diagnosis of this parasite?
400x microscope
I can't seem to be able to download the video. From the screenshot, it could be Strongyloides or Enterobius vermicularis(?) Pinworms(Enterobius) are also sometimes found in unusual sites. Try doing a perianal swab to check if pinworm eggs are present or a stool exam if Strongyloides larvae are present.
I agree with F. Mendoza this is either Strongoloides or Entrobius vermicularis. Pinworms are more likely to enter genitalia of female than man. What is the magnification?
probably rhabditoid strongyloides larva
It would be good to know where this is happening, if any recent travel in tropical country, and if the patient is or not immunocomptent.
JJ
As F. Mendoza mentions, it could be Strongyloides or Enterobius. Although its general morphology seems more suggestive for Enterobius than for Strongyloides, I agree with John Olav Alvsvåg's comment that Enterobius ectopic localisations are more commonly found in female patients. I wouldn't exclude the possibility of a free-living nematode through contamination of the urine. Was the sample collected in a sterile way or was it taken "from the toilet"?
Enterobius vermicularis, just my opinion as I experienced one slide look the same morphology
Looks more like Enterobius than Strongyloides, but certainly as explained by Idzi Potter it is important to know if the sample has been contaminated
Most likely it is rhabditiform larva of Strongyloides. The first-stage of rhabditiform larvae are 180-380 µm long, so please check the size.
The infection can occur by contamination from the intestine
It seems that the patient is immunocompromised and is infected with s. stercoralis. please order a stool exam and if you see s.s. larva start thiabendazole therapy.I hope that s.s dose not dessiminate in him but you must study this probability too.
stool exam will easily determine the parasite as it is originated their. Urine must be parasite sterile.
check the stool for confirmation. the parasite in tthe urine is probably due to contamination from the anal orifice.
Looks like Enterobius to me, I do not think it is Strongyloides as the morphology is not suggestive. Certainly it is a contamination from the anal area as neither of these parasites have access to the bladder
If you pay attention to the magnification of larva under the cover slide(400x) it is different from the size of Enterobious but according my friends comments the stool exam is the best way for final diagnosis.
This is more like strongyloides stercoralis infection. It has a tendency to become disseminated in immune-compromised patients such as the one in question. No wonder it is identified in the urine of the patient! (a most unusual site of infestation) This TB patient is likely immune-compromised. Vigorous treatment is needed to achieve a total cure.
The appearance is more towards Enterobius vermicularis but S.stercoralis be better excluded by proper stool examination. TB patients usually are not that immuno-suppressed to have disseminated strongiloidosis unless he is HIV positive. So better to check for HIV as well if not already done. Headaches, body aches and anxiety may be related to TB or drug induced (or related to HIV).
By size and morphology, it seems to be a larva of Enterobius vermicularis (Oxyurus). The egg shell most probably collapsed and liberated the larva.
Assuming that this is not a contaminating free-living nematode (although it could be in theory if the specimen container was not completely dry inside, or sterile, because these nematodes are ubiquitous in the environment), the differential diagnosis should include both Enterobius and Strongyloides. It is known that Strongyloides larvae can indeed be found in urine specimens. Furthermore, TB (as in this patient) can be an indication of concomitant HIV infection and, thus, an immunodeficient state could be prevailing; a situation potentially compatible with disseminated strongyloidiasis, although there used to be debate as to whether or not disseminated strongyloidiasis is an opportunistic infection in HIV/AIDS. This aside, the X400 magnification does not fit directly with either Enterobius or Strongyloides in relation to the profile picture associated with the question. Not as the image appears on the computer’s screen, anyway. I can't access the video at present, so haven't seen it. The presence of an adult Enterobius worm in a urine specimen from a female person would be easy to understand because as other replies to the question have indicated, Enterobius is known to occur in the vagina as an unusual phenomenon (the vagina has even been said to be a "potential reservoir" - Kashyap et al., 2014), although female urinary tract infestation is not entirely unknown (Patel et al., 2015). How the worm would end up in urine from a male individual (the urine sample concerned was from a male patient), is less readily explicable. Perhaps it could for example drop off into a container somehow from the perianal region if a patient urinates while standing; but see Zahariou et al. (2007). Because of past research of mine, I can make the comment that it would sometimes be easy to confirm a tentative identification of a helminth as Enterobius if the worm is examined at high magnification. This is because if it is an Enterobius female, the characteristically shaped, thin-walled eggs of Enterobius can often be seen inside it. However, the microscope’s light must not be turned up too brightly, or one might look straight through the eggs, so to speak. As other people who answered the question have said, examination of faecal specimens (and the perianal area by means of standard diagnostic techniques for Enterobius) should now be carried out. REFERENCES: Kashyap, B. et al. 2014. Recurrent paediatric pinworm infection of the vagina as a potential reservoir for Enterobius vermicularis. Journal of Helminthology 88: 381-3; Patel, B. et al. 2015. Enterobius vermicularis: an unusual cause of recurrent urinary tract infestation in a 7-year-old girl: case report and review of the literature. Tropical Doctor 45: 132-4; Zahariou, A. et al. 2007. Enterobius vermicularis in the male urinary tract: a case report. Journal of Medical Case Reports 1: 137.
I have checked the stool, found no eggs. however, I have given the treatment with pyrantel pamoate.
thank u all
I suspect strogylides stercoralis as the eggs of enterobius cannot be found in feaces. strogylides larva is very active nd may have migrtrate to the urine by uto infection.
Strongyloides stercoralis larvae.
In the diagnosis, not only tests for the presence of intestinal carbide in feces are performed. The material for the examination may also be duodenal content, sputum, saliva or urine - here you can find the parasite's larvae. The most commonly associated with infection is the occurrence of symptoms such as abdominal pain, lack of appetite, weight loss, anemia, diarrhea, irritability and insomnia.
Hi
This parasite may be a nematode larva. If the patient is a female, it is more likely that the nematode larvae are especially oxyureas.
Tanks
I couldn't see the video and buccal cavity is not clear. Since the specimen is urine at 400 X, it is likely to be the hatched larva of Enterobius vermicularis.
I study in all women with recurrent cystitis and vulvovaginitis eggs of enterobius and Ascaris in urine. Recommend to do this !!!
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