A number of years ago, while working in a Microbiology Laboratory, we received a call from the hospital intensive care unit. It was the charge nurse calling to alert us about a specimen that was coming to the laboratory for analysis and how it was that it should be ordered. The specimen was going to be a collection of fluid that was obtained from a normal saline wash of the patient’s bronchus. Approximately 50ml was aspirated and collected into a container. The pulmonary physician observed unusual particulate material in the cloudy turbid fluid collection and therefore requested that it be sent to the laboratory for further analysis.
The patient’s history is as follows. The patient was a 95-year-old male who had become unresponsive at home and subsequently hospitalized with a diagnosis of acute pyelonephritis. The patient on day 6 of his hospitalization developed a sudden onset of coughing and wheezing. A nasal discharge and coarse crackles were noted in his physical examination. Haematological investigations were normal. The chest X-ray was normal. The patient had a total IgE level that was approximately 312 IU/ml and the bronchial aspirate was suggestive of an eosinophilic pneumonia.
When we received the specimen the fluid was rather turbid with a white sediment on the bottom of the container. A gently swirling of the fluid disturbed the sediment and we were able to see very small objects of consistent shape and size. Some of the objects were aspirated and gently deposited on a clear glass slide to observe under a dissecting scope. The objects were creamy-white in color and measured about 2mm in length. The objects were all actively moving on the slide. A photo of one of the objects is shown below.
What is the object seen in the photo and what is your diagnosis?
What predisposing factors place a patient at risk for this?
What is the treatment of choice?