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Help with organism identification

Steve J. Upton coccidia at ksu.edu
Thu Jun 26 11:41:28 EST 1997

Charles Cartwright wrote:
> 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.
> Thanks,
> Charles P. Cartwright Ph.D.,
> Director of Clinical Microbiology,
> Hennepin County Medical Center,
> Minneapolis, MN
> charles.cartwright at co.hennepin.mn.us

Dear Dr. Cartwright,

Off the top of my head, about the only flagellate that I know that is
"supposed" to be there is Trichomonas tenax.  However, it is possible
that some other flagellate from the environment was able to colonize
this host.  My suggestion would be to make a series of stained smears
that can be sent around to a few investigators (I would certainly like
to take a look), and I think your decision to try metronidazole is a
logical choice.

Sincerely yours,

Steve J. Upton, PhD
Division of Biology, Ackert Hall
Kansas State University
Manhattan, KS 66506
(913) 532-6639

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