Case #473 – August, 2018

A 67-year-old female presented with a 2-3 day history of lower back pain. She also reported a burning sensation all over her body. The patient’s history included emphysema of the lungs, history of smoking, pancreatitis, and cholelithiasis. She underwent endoscopic retrograde cholangio-pancreatography (ERCP) at which time a worm was detected in the common bile duct and removed. The worm was damaged during retrieval but images were taken of what was obtained and sent to the DPDx Team for diagnostic assistance. Figures A and B shows the portion of the worm recovered. What is your diagnosis? Based on what morphologic features?

This case and images were kindly provided by St Joseph’s Hospital – HealthEast, St Paul, Minnesota.

Figure A

Figure B

This was a very remarkable case of hookworm infection as adult worms are rarely found in bile ducts. Morphologic features shown included:

a short, muscular, bulb-shaped esophagus.
a marked, anterior “hook” shape.
a large buccal cavity with cutting plates (Necator americanus) vs. teeth (Ancyclostoma duodenale).

Further clinical history of the patient included a history of Helicobacter pylori and hookworm infections. In addition, a follow-up stool specimen was received on the patient and hookworm eggs were observed on a concentrated wet-mount.

More on hookworm infection: https://www.cdc.gov/dpdx/hookworm/index.html

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/.