Working in an inner-city hospital more than often can be challenging as a physician as well as rewarding. That holds true for all healthcare professions in an inner-city hospital. It’s in the fast-paced environment of these hospitals, and the melting pot of the surrounding population, where the exposure to a plethora of human conditions and infections provides an invaluable experience unmatched in other hospital environments. And in so doing, makes you better in your profession. Whether it be a physician, radiologist, physical therapist, pharmacist, nurse, medical technologist, etc.
After many years of working in an inner-city hospital environment, I now work in a smaller hospital. Working in a smaller hospital with a limited population, age group, gender, makes me sometimes long for the challenge and the unexpected of an inner-city hospital. For that comradery and banter between healthcare professionals as we help each other for the good of the patient. An interaction spurred by the genuine intellectual curiosity of a scientist and the caring of healthcare professionals focused on a common goal. The health of a fellow human. Yes, it sounds corny. But in nearing the last years of my career I can still remember why I chose what I do and still approach it with the curiosity that I started with.
So, this case study is one that was somewhat unexpected. It was early in my Microbiology career. Yet it was impactful in ways that were surprising.
I originally started working as a Microbiologist in an inner-city laboratory. Most days were fast paced and incredibly busy. This particular day was shaping up to be a typical busy middle to end of the week. Basically, it was a constant wave of specimens. Not for the faint of heart as many of the specimens required special attention, requirements, and consultations with an Infectious Disease Physician or a Pathologist. But I was holding my head above water. That is until a visitor came to the front window asking for advice.
The visitor was the Head Cook for the hospital. He was an imposing middle-aged man with a tall chef’s hat and white apron. He had the look and demeanor that one would picture a chef having. He asked me if I could identify worms. A strange question, nevertheless I asked him what kind of worms and from where. He said that he had noticed what looked to be small worms on the surface of his passed stools. I had my reservations of what he thought looked like worms but entertained his suspicions by asking that he bring a stool specimen up to the laboratory for me to analyze the next time he passed any stool with what he described as “small” worms.
To my surprise he returned about an hour later with a stool specimen in an emptied butter container. A somewhat strange and amusing choice for a specimen container. But I must admit resourceful. I took his extension and told him I would call him in an hour or two with my findings.
Macroscopically the stool specimen was well formed with no evidence of mucous or blood on the surface. Curiously there were small thread-like objects scattered on the surface that were approximately 8-13 mm in length with a thickness of .3-.5 mm. I gently pulled one of the thread-like objects and placed it in a sterile specimen container containing a small amount of isotonic saline. I then aspirated the object into a sterile plastic pipette and dispensed the object on a clean glass slide to look at under the microscope. The images below are some photos of what I observed microscopically at 10X magnification.
I then carefully slit the side of the object which resulted in the release of its contents. The contents were exposed to Lugol’s Iodine to better observe under the microscope. The image below is a photo of the contents observed with high immersion oil magnification.
Answer the following questions:
Can you identify the thread-like objects that are observed microscopically in the images provided?
Is this an unusual finding in terms of where this organism is usually found?
What is the normal diagnostic form detected in a laboratory and how?
Why was this finding of special concern in this individual considering his job?
And lastly, what is the standard treatment and challenges in the treatment of this infection?