A long time ago when I was first starting out as a Medical Technologist, I was working the weekend shift when I got a call from the laboratory front desk secretary. Back then we worked with just two technologists in a very busy lab serving an inner city hospital. The work was interesting and exciting because every day held the promise of finding something new. Interactions with nurses and physicians were common and welcomed. So when I got the call I fully expected it to be a referral to the Microbiology Lab for some type of consultation.
Immediately when I answered the call I could hear the sound of laughter at the other end. Followed by the secretary requesting that I come to the front desk. I asked what for and she said “There are three female models here requesting you by name”. Now, I had been accustomed to the occasional pranks from my colleagues and to be honest I most likely deserved them as retaliation for my pranks against them. But this was the weekend, it was busy, we were short. Not a time or place for pranks. I expressed my annoyance at being bothered but was assured that this was not a prank. So I grudgingly walked down to the front desk which was a considerable distance from the Microbiology Lab.
As I approached the front desk I immediately noticed and made eye contact with three young women that could only be described as models. When I asked what I could do for them one stepped toward me and presented me with a jar wrapped in aluminum foil. She explained that her physician had told her to bring the jar to the lab and asked for me to make the identification of the contents. She proceeded to tell me that she had found them in her bed and had one coughed up and another migrate out of her nose. When I peeled off the aluminum foil it was a jar half filled with what looked like the earthworms I would use to fish with. I told her to call her physician in a half hour. I assured her that I would call the physician immediately with the identification and that the proper medication would be prescribed. Her travel history was significant for a recent one month modeling assignment in Portugal. Coincidentally her friends, whom had also gone on the assignment, were complaining of vague abdominal discomfort and occasional diarrhea.
I took the worms to the laboratory and placed one under a dissecting microscope to look at the worm close up. My illustration below depicts pretty accurately what I saw. The idenitifcation was fairly easy to make. The worm was approximately 31cm long and three “lips” at the anterior end of the body could be seen. Some of the worms were active and moved with an uncharacteristic thrashing motion. The surface of the worm was not segmented like that of an earthworm but instead smooth.
If a stool specimen was collected for ova and parasite examination, considering that the number of worms expelled indicate a heavy worm burden, you would expect the following egg to be seen in the formalin/Lugo’s Iodine stain concentrate portion of the examination (see image below).
- What is the identification of the worm(s) expelled from this young woman?
- What might precipitate the outward migration of these worms?
- The image of the egg can be described as how?
- How is this parasitic infection acquired?
- Considering the assumed heavy worm burden, what complications can you worry about?
- The eggs of this worm are very resistant to?
Discussion to follow!