We had rather an unusual appearing organism in a patient specimen
today..and I am curious if anyone has any idea what it might be. The
patient is a rather complicated case, but basically he is a C3 spinal
injury case (quadraplegic) with mutiple medical complications arising
from his injury. He was admitted to the hospital for unrelated problems
but was noted on admission to have some respiratory symptoms...including
a mucusy discharge from his ET tube. A BAL was performed and specimens
submitted for routine diagnsotic workout. Late this afternoon, one of
the hematology techs came rushing over to microbiology telling us than
something was moving under her hemocytometer! We went to take a look,
and sure enough there were several what appeared to be flagellate
protozoans 'twitching' around under the microscope.
We did a more careful examination of the organism back in the micro
lab...but so far noone has been able to come up with an ID! The organism
is clearly flagellate, about the size of a trichomonad. It is oval to
round, with a protrusion at the (I assume) posterior end with a very
distinctive bunch of flagella (I would estimate at least 10-12). These
were very vigorously moving, although we could not determine how the
organism moved because they were trapped in cellular debris and mucus.
Nothing in the various parasitology textbooks contained any organisms
even remotely resembling this. The patient has no travel history (he is
from Minnesota), and the only remarkable thing is his general poor state
of helath and personal hygiene.
Physicians decided to add metronidazole to his antimicrobial coverage
figuring that the organism will respond like Giardia/Trichomonas.
Any and all thoughts on an identification are welcome. We will be
consulting with some expert parasitologists in the next couple of days,
and I will follow up with an answer! Please send e-mail responses to the
address at the moment of this message.
Charles P. Cartwright Ph.D.,
Director of Clinical Microbiology,
Hennepin County Medical Center,
charles.cartwright at co.hennepin.mn.us