Author: Tianmen First People's Hospital, Department of Clinical Laboratory, Zhu Mingchao, Bruce Lee
One day, at work, a pediatrician called and asked us if we routinely looked at parasites? She said that there was a patient who had seen the bugs the other day, but your routine stool checks were normal. I immediately wrote down the patient's name and hospital number, and since the stool samples of the day had been discarded, I asked the doctor to prescribe another stool routine review.
Hanging up the phone, I went to check the results of this patient before, because the department is using a fecal automatic analyzer, even if the sample is lost, each sample detected by the instrument will be photographed and left, I found the corresponding number of the picture, high times low times a total of 24 pictures, but all the pictures did not see any suspected eggs or insect bodies. There are no obvious abnormalities in the shape of the stool, so it is no wonder that the test was missed. Then see if the patient has done a blood routine, as shown in the figure.
Patients had two blood routine tests, both of which showed eosinophilia, E: 11.3% and 11.7%, soil-derived helminth infection, often lead to peripheral blood eosinophilia, it seems that the patient is likely to be a helminth infection. The next day, the patient's stool routine was sent over again, and the colleague on duty first found the parasite eggs on the microscopy, but he was not sure what the eggs were, so I went to help her see. I immediately smeared a stool smear and as soon as I went there I saw the eggs, as shown in the picture.
10x
40x
So I went to do another egg set to prepare to save the sample. Immediately after the egg collection, I applied a sheet ready to look at the fine structure with an oil mirror, as shown in the picture.
100×
Very beautiful high-definition pinworm eggs presented in front of the eyes, because it was busy at the time, I did not discard the slides, but put them on the shelf next to me, and when I finished other work, when I looked at it again, the film was completely dry, thinking of losing it, I put it on a slide rack, so after two days, I picked up the film again to see if the shape of the eggs had changed, but when I looked at it again, I was stunned by the scene in front of me!
It turned out that after two days of drying, no moisture, no soil, the larvae in the eggs were actually still alive, and the larvae could be seen squirming, and there was a kind of fear that struck in an instant, and the life force of the pinworm was indeed tenacious enough, no wonder it was reported that the pinworm eggs could survive for 10 days in the patient's nail scale or on the skin [1], and could survive for 20 days under suitable external conditions [2]. It is true that the soil source does not need soil, and the outside world is developing. It is precisely because of the rapid development of the eggs, fast transmission speed, strong resistance of the larvae and other characteristics, resulting in the phenomenon of "easy to treat and difficult to prevent".
Dry on the fourth day
Dry on the fifth day
Two days later, I looked again at the larvae inside the eggs and there seemed to be no sign of movement, but the larvae inside the eggs did not seem to have dried yet, and whether they were completely dead or not needed to be further verified, so don't underestimate this small egg, it is likely to cause a cluster infection.
The culprit of the child's abdominal pain and chattering is a pinworm infection. A small oversight at work can cause a missed diagnosis of a disease. Behind every specimen is a living life, and perhaps it is the one more you look at in the microscope that becomes a turning point in the diagnosis of the disease. The crowd searched for "it" for a thousand hundred degrees, and suddenly looked back at the worm but it was in the middle of the light.
【Reference】
Shen Jilong, editor-in-chief. Clinical Parasitology and Testing[M].Beijing:People's Medical Publishing House, Third Edition.2010:29.
Zhu Xinping,Su Chuan. Human parasitology[M]. 8th ed. Beijing: People's Medical Publishing House, 2016:163.