There are times when the Microbiology Laboratory is called on to make an identification of an arthropod retrieved from a patient directly, a patient’s clothing, or their living quarters. Most laboratory microbiologist in my experience tend to avoid making identifications because it is out of their comfort zones. Therefore there always seems to be the same one or two technologists that step up to make the identification. I find it challenging and interesting. The following is an example of how this seemingly simple laboratory test can be difficult and can impact patient care.
An emergency room nurse is taking the vitals of a patient that comes in complaining of a sore throat. The patient is a familiar homeless 75-year-old male labeled as a “frequent flyer” by the staff. He is generally pleasant and searching for a free meal or water which he knows he will get during his examination and if lucky, admittance to the hospital.
He has a history of alcohol abuse, and smoking. But over-all his health history has been generally good considering his lack of shelter and subpar nutrition. He served in the military for 20 years but does not participate in taking advantage of any of his veteran’s healthcare benefits and prefers to instead seek medical care in the emergency room as needed. As a result, he does not have a primary physician but has a detailed medical record history at the hospital.
His throat examination is unremarkable. There is no erythema, exudate, nor inflammation. No cervical lymphadenopathy noted. The patient is afebrile. A rapid throat test for Streptococcus pyogenes is performed and the result comes back as negative.
A complete blood count was ordered along with a metabolic profile. All results were within normal limits.
The consensus from the medical staff was that he was not ill and was perhaps seeking some temporary shelter and nutrition.
As he was being discharged from the emergency room a nurse noticed an insect crawling from under the collar of the patient’s jacket. She immediately placed it in a sterile cup and sent it to the laboratory for identification. A photo of the arthropod is shown below and was measured at 14mm in length:
Can you answer the following questions:
What is the identification of the arthropod seen in the photograph from the homeless patient?
Is this considered an ectoparasite?
Does it transmit any diseases?
Where are you most apt to encounter this arthropod?