Beautiful "surprise" - I meet with hooks

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Beautiful "surprise" - I meet with hooks

2021-11-27 18:08:20 38 ℃

| Zhou Shi Mei

Unit | Yulin First People's Hospital Laboratory

Preface

Unconsciously, it has been a year in the test department for a long time. Among them, I have the longest rotation in the body fluid group. If you ask, which job do you like most in my body fluid group? I will tell you without hesitation! Although some people may worry because of the smell, work content, I will be happy every day because of finding a different thing.

Case

An exemption of a tramine was sent to the test department: the specimen is ink green, raasant. Such an abnormal specimens successfully caused my attention, would I want "some materials"?

I am looking forward to painting the slice test, the first ... second ... I am a little discouraged, I want to give up, but holding the last hope, I put uniformly pumen into physiological saline. The stool specimen, continue to apply the film, haha, finally found you - hook eggs.

Figure 1 Dip of the ink green rays of physiological saline

Figure 2 Low Mirror (10x) mobile phone enlarges three hook eggs, of which red circles are hovering hooks, yellow circles are larval hook eggs.

Figure 3 Under high magnification (40X) mulberry period hook egg

Figure 4 High-speed mirror (40X) two larvae hook eggs

Video 1 High Mirror (40X) mobile phone enlarge version video times (3X) is preparing to cover the shell and slowly creepy larvae

The hook ovate is elliptical, colorless and transparent, size (56 ~ 76) um × (35 ~ 40) um, and the ovarine is thin. When the feces are discharged, there have been obvious voids between 4 to 8 ovaries, ovars and egg cells. If the patient's constipation or feces is placed for a long time, the ovars can be divided into multiple, which becomes a mulberry period, and even develop as larva.

Although I have worked for a period of laboratory, I have never found hook in the laboratory, but I have seen its true appearance in the textbook, so I have a "small insect" in the laboratory. The specimen was placed at room temperature for 24-48 hours, and finally successfully smashed the "true capacity".

Figure 5 High magnification (40X) hook

Video 2 high allathroscopic (40X) mobile phone enlarged version of video times (x2) is slowly creep hook

Hook, divided into two stages of rod-shaped and filament. The rod-shaped wall is transparent, the front end is blunt, and the rear end is sharp. The mouth is elongated, with a hole, the front section of the pharyngeal tube is thicker, the middle section is fine, and the latter is swayed. There are two rods, and the first rod-like size is approximately (0.23 ~ 0.4) × 0.017 mm, and the second phase rod size is about 0.4 × 0.029 mm. The filament is about (0.5 ~ 0.7) × 0.025 mm, the oral cavity is closed, and there are 1 hornic spectrous structure in the back and abdomen of the cavity wall at the junction of the pulp.

Hook induction

ANCYLOSTOMISISISIS is a duodenal hookworm or a disease caused by a hooked inworm. The hook larvae is moved in the human body. The adult is mainly parasitic in the empty intestine, and a few parasitic is in the twelve intestines and the intestines. Report of the stomach and colon.

Hookworm larvae can be hook-like dermatitis, the pathogenic mechanism is a type I hypersensitivity reaction; it can also cause respiratory symptoms, patients can have cough, blood, often accompanied by fever, chill-cold body symptoms, resulting in hook Pneumonia. Also causes eosinophils to increase their asthma, and even heavy blood.

Insects can cause digestive tract symptoms, patients can have symptoms such as upper abdominal discomfort or pain, stomach, indigestion, diarrhea or constipation. Hook inworms are involved in the report of bleeding in the digestive tract, often harmful due to misdiagnosis, worthy of attention.

The adult can also cause anemia, the main harm of anemia is that the adult can lead to a chronic blood loss of the host, the reason is that hookworm secretes anticogeneous, which is conducive to it. The bite is attached to the mucosal wound. The worms often replace the bite, causing the original wound to continue to be blood.

In addition, the insects sides of blood. Resulting in chronic blood loss of patients, due to continuous loss of iron and proteins in their body, there is a poor anemia in hyperbreneous small cells. The degree of anemia depends not only on the number of hookworms, but also related to host health, nutrient conditions. Eosinophils in patients with acute hookworms are more than 15%, up to 86%, and increased with leukocytes.

The diagnosis of laboratory is the basis for the examination of hook eggs or hatch hooks in feces. The saturated brine floating polymerization method is the preferred diagnosis method of hooks. The detection rate of the hook-hook culture is similar to the saturated saline floating polymerization method, but the biological saline direct mirror test is high.

Figure 6 Harm life history line chart

A. Parasitic part: small intestine; b. Ovulation pathway: with the feces; C. Diamese period: insect ovulation; d. Infection stage: filamental 蚴; e. Infection: contact surface; f. Infection route: skin, mouth Waiting for; g. Pathogenic insect: adult, larvae

Hookworm disease is one of our rural fluttering. The epidemic of hooks and the development of shoulders and larvae development, survival natural conditions, feces contaminated soil, and local production and lifestyle and other factors. Therefore, advocating the shoe under construction, hand-foot skin can be painted to prevent infection. Commonly used drugs: Apheniazole and toluenemimidazole.

case analysis

Medical logistics: Huang, female, 70 years old, farmers, due to "3 years of peritoneal dialysis treatment, blood pressure is less than two years" by emergency 120 into the hospital, followed by "Chronic kidney disease period 5" to collect kidney medicine. Previous long-term external hospitals regular peritoneal dialysis treatment, inscribed intraperitoneally fixed in place. Temporary tubes on the right side are fixed. Laboratory examination:

Figure 7 patient blood routine report

Figure 8 Patient biochemical report

From the report, the patient is mainly kidney problems, accompanied by anemia, low proteinide, and eosinophils, there is no obvious clinical characteristics after infection with hooks, may be early infection of hooks, And the number of hooks invasive and fewer parasitic numbers in the human body. The patient's clinical manifestations are also related to the health of the host, nutritional conditions, immunity, and the like.

Summarize

This case tells us that as a test worker, in daily work, every specimen should be taken patiently, and the abnormal specimen must be carefully identified by multiple manual smear tests, and combined with the patient's clinical features, it can Improve the detection rate of parasites. However, when the patient's clinical characteristics are not obvious, they can't fall, and maybe there will be "surprise".

references

[1] Wu Zhongdao and other editor-in-chief. Clinical parasitic insect test. 3rd edition. Beijing: China Pharmaceutical Technology Press, 2015.8

[2] Yang Shaki, Ren Hong.Pathics [M]. 7th Edition. Beijing: People's Medical Publishing House, 2008.310-312.

Description: This article is original submission, does not represent the idea of ​​testing medical media. Please indicate the source and the original author name and unit when reprint.