Case #381 – October 2014

A man was seen as an outpatient at a hospital in Atri, Italy. A stool specimen was collected and processed for ova-and-parasite (O&P) testing. Images of suspect parasites were taken and sent to the DPDx Team for diagnostic assistance (Figures A and B). Measurements shown were included in the original telediagnosis submission. No other information was available. What is your diagnosis? Based on what criteria?

Figure A

Figure B

The objects shown were the eggs of the trematode Dicrocoelium dendriticum. Diagnostic morphologic features shown in the figures included thick-shelled, dark brown embryonated eggs within the size range for D. dendriticum (35-45 µm long by 20-30 µm wide). Like with many cases involving trematodes, the operculum was not readily visible on either of the eggs. Most infections are light and asymptomatic. However, eggs found in stool can sometimes represent spurious passage and additional specimens should be collected to confirm a true infection.