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        DPDx - Laboratory Identification of Parasites of Public Health Concern
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        Case #247 – March, 2009
          Case #247 – March, 2009
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                A patient, originally from Ethiopia but living in the United States for the past five years, presented to her primary care provider with complaints of abdominal pain. A computed tomography (CT) scan was performed, and cysts were observed in the liver. Serologic testing for Hepatitis B Virus, amebiasis, and echinococcosis were all negative. An aspirate from one of the cysts was drawn, and sent to a pathology laboratory for work-up. Slides made from the specimen were eventually forwarded to the CDC-DPDx for diagnostic assistance. The following images show was what observed on a Papanicolaou-stained (PAP) slide of the specimen. Figures A, B, C and E were taken at 500x magnification; Figures D and F were taken at 1000x magnification. What is your diagnosis? Based on what criteria? What other testing, if any, would you recommend?
                    Figure A
                    Figure B
                    Figure C
                    Figure D
                    Figure E
                    Figure F
                  Case Answer
                        This was a case of echinococcosis, caused by a tapeworm in the genus, Echinococcus. Diagnostic features included:
                          * the presence of multiple protoscoleces in the hydatid cyst (Figure A).
                          * the presence of evaginated protoscoleces (Figure C).
                          * the presence of hooklets consistent with those of the Taeniidae.
                          * the presence of calcareous corpuscles.
                        Many of the protoscoleces observed in this specimen were in a state of degeneration, resulting in the liberation of free calcareous corpuscles and hooklets (best seen in Figures E and F, respectively). The term used to describe the particulate matter within a hydatid cyst, including degenerating protoscoleces, hooklets, calcareous corpuscles and daughter cysts, is ‘hydatid sand.’ Although the species was not identified in this case, the travel history best supports E. granulosus.
                        The DPDx Team also recommended sending another serum specimen for reference testing at the CDC. Testing on the follow-up serum specimen was positive for echinococcosis using the CDC immunoblot. If a parasitic disease is suspected, but serology results are equivocal or inconsistent with the clinical diagnosis, repeat testing at a reference laboratory is recommended.
                        More on: Echinococcosis
                This case was kindly provided by CellNetix Pathology in Seattle, WA.
                Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.
      DPDx is an educational resource designed for health professionals and laboratory scientists. For an overview including prevention, control, and treatment visit www.cdc.gov/parasites/.
      Last Reviewed: August 24, 2016
        Source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Parasitic Diseases and Malaria
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      * Diagnostic Procedures plus icon
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              o Safety
              o Specimen Collection
              o Specimen Processing
              o Shipment
              o Staining
              o Microscopic examination
              o Molecular diagnosis
              o Extraction of DNA from blood specimens
              o Detection of parasite antigens
              o Isolation of organisms
              o Special tests
              o Inactivation of Ebola/Marburg for malaria testing
          + Stool Specimens plus icon
              o Safety
              o Specimen Collection
              o Specimen Processing
              o Shipment
              o Staining
              o Microscopic examination
              o Detection of parasite antigens
              o Molecular diagnosis
              o Extraction of Parasite DNA from Fecal Specimens
              o Morphologic comparison of intestinal parasites
          + Serum/Plasma Specimens plus icon
              o Safety
              o Specimen Requirements
              o Specimen Submission
              o Detection of Antibodies
              o Antibody Detection Test
          + Other Specimens plus icon
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              o Tissue
              o Tissue specimens for free-living amebae(FLA)
              o Isolation of Leishmania organisms
              o Sputum
              o Aspirates
              o Sputum, induced sputum, and bronchoalveolar avage (BAL)
              o Vaginal swabs for diagnosis
              o Procedure for demonstration of pinworm eggs
              o Urine
              o Whole Organisms
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