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Plant root hair in tap water: a potential cause for diagnostic confusion.

Shakoor S, Wasay M, Zafar A, Beg MA - Korean J Lab Med (2011)

Bottom Line: Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye.We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion.Therefore, tap water should be considered a source of root hair and vegetable matter.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan. sadia.shakkoor@aku.edu

ABSTRACT
Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.

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Related in: MedlinePlus

Wet mount preparation with saline of 2 separate sections of the brain tissue. The structures shown created a diagnostic dilemma as such artifacts are not common: (A) shows 2 distorted structures that have a definite outer covering but no pseudocoelom, (B) shows a tapering structure with a central refractile core, more suggestive of a root hair.
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Figure 1: Wet mount preparation with saline of 2 separate sections of the brain tissue. The structures shown created a diagnostic dilemma as such artifacts are not common: (A) shows 2 distorted structures that have a definite outer covering but no pseudocoelom, (B) shows a tapering structure with a central refractile core, more suggestive of a root hair.

Mentions: A 57-yr-old man under treatment for tuberculous meningitis and hydrocephalus was admitted to a tertiary care hospital for the investigation of drowsiness. He had been receiving first-line anti-tubercular treatment (ATT) and 10 mg/day of prednisone for the past 5 months. The initial workup included a head computed tomography scan, which showed multiple small space-occupying lesions in both the cerebellar hemispheres. The baseline laboratory workup included complete blood count, urinalysis, and stool examination, the results of which were normal. A craniotomy and biopsy were also performed, and the perioperative findings were unremarkable. The tissue samples were sent for histopathological examination and bacterial and mycological culturing. Microscopic examination of a potassium hydroxide (KOH)-treated tissue sample showed a single 2-mm structure resembling a "worm," with tapering ends. The same tissue sample was re-examined for this structure by teasing the tissue with a sterile scalpel and suspending it in sterile saline; similar segments were seen (Fig. 1), and a diagnostic dilemma arose as to the identification of these structures. The initial histopathological findings had not revealed similar structures. Therefore, we re-examined various areas in the tissue by repeated sectioning. Meanwhile, the attending physician was alerted to the possibility of Central Nervous System (CNS) helminthosis, and an empiric treatment with 200 mg/day of albendazole was initiated, while additional clues to a disseminated helminthic infection were sought. However, the peripheral smear examination did not reveal eosinophilia, and the 3 stool examinations were negative for larvae. No such helminth-like structure was seen on examination of the different sections of the tissue, although minimal inflammatory cells and reactive glial cells were noted. Finally, parasitic infestation was ruled out, the albendazole treatment was discontinued, and the patient was tentatively diagnosed with a tuberculoma.


Plant root hair in tap water: a potential cause for diagnostic confusion.

Shakoor S, Wasay M, Zafar A, Beg MA - Korean J Lab Med (2011)

Wet mount preparation with saline of 2 separate sections of the brain tissue. The structures shown created a diagnostic dilemma as such artifacts are not common: (A) shows 2 distorted structures that have a definite outer covering but no pseudocoelom, (B) shows a tapering structure with a central refractile core, more suggestive of a root hair.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3111035&req=5

Figure 1: Wet mount preparation with saline of 2 separate sections of the brain tissue. The structures shown created a diagnostic dilemma as such artifacts are not common: (A) shows 2 distorted structures that have a definite outer covering but no pseudocoelom, (B) shows a tapering structure with a central refractile core, more suggestive of a root hair.
Mentions: A 57-yr-old man under treatment for tuberculous meningitis and hydrocephalus was admitted to a tertiary care hospital for the investigation of drowsiness. He had been receiving first-line anti-tubercular treatment (ATT) and 10 mg/day of prednisone for the past 5 months. The initial workup included a head computed tomography scan, which showed multiple small space-occupying lesions in both the cerebellar hemispheres. The baseline laboratory workup included complete blood count, urinalysis, and stool examination, the results of which were normal. A craniotomy and biopsy were also performed, and the perioperative findings were unremarkable. The tissue samples were sent for histopathological examination and bacterial and mycological culturing. Microscopic examination of a potassium hydroxide (KOH)-treated tissue sample showed a single 2-mm structure resembling a "worm," with tapering ends. The same tissue sample was re-examined for this structure by teasing the tissue with a sterile scalpel and suspending it in sterile saline; similar segments were seen (Fig. 1), and a diagnostic dilemma arose as to the identification of these structures. The initial histopathological findings had not revealed similar structures. Therefore, we re-examined various areas in the tissue by repeated sectioning. Meanwhile, the attending physician was alerted to the possibility of Central Nervous System (CNS) helminthosis, and an empiric treatment with 200 mg/day of albendazole was initiated, while additional clues to a disseminated helminthic infection were sought. However, the peripheral smear examination did not reveal eosinophilia, and the 3 stool examinations were negative for larvae. No such helminth-like structure was seen on examination of the different sections of the tissue, although minimal inflammatory cells and reactive glial cells were noted. Finally, parasitic infestation was ruled out, the albendazole treatment was discontinued, and the patient was tentatively diagnosed with a tuberculoma.

Bottom Line: Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye.We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion.Therefore, tap water should be considered a source of root hair and vegetable matter.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan. sadia.shakkoor@aku.edu

ABSTRACT
Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.

Show MeSH
Related in: MedlinePlus