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Case #259 - September, 2009

A four-year-old child was admitted to the hospital for sever abdominal pain mimicking appendicitis. A small section of bowel was removed and sent to the Pathology Department for work-up. A section of tissue was preserved in formalin, sectioned, and stained with hematoxylin and eosin (H&E). Images A-C show what was observed at 100x magnification of slides made from the tissue specimen. In addition to the biopsy, stool was collected for routine ova and parasite (O&P) examination. The object is Figure D, which measured on average 73 micrometers long by 37 micrometers wide, was seen in low numbers in a concentrated wet mount from a formalin-preserved aliquot of the stool. What is your diagnosis? Based on what criteria?

Case259_A

Figure A

Case259_B

Figure B

Case259_C

Figure C

Case259_D

Figure D

Case Answer

This was a case of hookworm infection caused by a member of the genus Ancylostoma or Necator. An examination of intact mouthparts of the adult or male sexual structures is necessary for genus-level identification. Diagnostic features included:

  • a longitudinal section of an adult hookworm in tissue demonstrating the oral cavity (OR, Figure A) and a strong, muscled esophagus (ES, Figure A).
  • cross-sections of an adult hookworm in tissue demonstrating platymyarian musculature (MU, Figure B), coiled ovaries (OV, Figure B), excretory ducts (ED, Figure B), and an intestine with a brush border (IN, Figure B).
  • partially-embryonated eggs in stool with a thin, hyaline shell and within the size range (60-75 micrometers long by 35-40 micrometers wide) for hookworm (Figure D).

Figure A

Figure B

More on: Hookworm

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.

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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.

  • Page last reviewed: August 24, 2016
  • Page last updated: August 24, 2016
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