Dr. Utkarsh Sharma
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am writing as I found something in my mum's sputum (parasite or blood) that I cannot identify. I have images on a 1:1 ratio and also magnified. She had chronic diarrhea and dermatitis. She responded well to Niacin. Her diarrhea is only occasional now. She is anorexic, fatigued, and very frail. She refuses most meals and has food fads (at one point was only wanting ice cream). She is very restless and unable to sleep for long. She looks pale and a bit restless. She has no motivation. She is not reporting any abdominal pain. She is very flatulent. We have to make sure all her food is very soft. She complains of things getting stuck between her teeth. She has not seen a dentist in decades. She seems to dab her saliva often, although her mouth looks dry. I asked her to rinse her mouth and spit again, but it did not elicit more of these things. Her breathing is normal. I wanted help identifying the organisms in her sputum. History of medical conditions: History of alcohol abuse, but currently not taking alcohol. She had extreme weight loss gradually over the years, and she is 85 years old. Current medication details: No medications.
Hello,
Welcome to icliniq.com.
I can understand your concern and will definitely help you regarding it. I have seen all the attached images (the attachment removed to protect the patient's identity). In the first two images, it actually seems like a blood clot. However, in the last two of them, specific beads give it a shape that makes it difficult to label it as a blood clot, but it does not fit for a common parasite as well. I suggest you submit it for a laboratory microscopic examination for a definitive diagnosis. A raised eosinophil count will point toward a parasitic infestation in blood work. On the other hand, raised neutrophil count and ESR (erythrocyte sedimentation rate) or CRP (C-reactive protein) will point towards infection in the lungs, which can cause spitting blood in sputum. I wanted to ask if she actually coughed (which means it came from the lower respiratory tract) the sputum. Or was it just in saliva? Talking about the difficult lifestyle of your mom, as you said she responded to Niacin, I would like to tell you that niacin deficiency also causes a condition called dementia which results in loss of cognitive functioning, which is evident from the symptoms you mentioned. A complete blood count can reveal anemia (reason for appearing pale). A complete physical examination is necessary at this stage as the symptoms are very diverse. Maybe an ultrasonographic examination will also be required. Once all the organic causes are excluded, a search for psychomotor causes will be done. I hope this helped, please take care.
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Pathology
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