Image Based Question-72048

A patient presented with ‘Frothy’, greenish vaginal discharge with a ‘musty’ malodorous smell.Pap Smear shows the following abnormality.What would be the treatment of choice?

A. Penicillin.

B. Ceftriaxone.

C. Fluconazole.

D. Metronidazole.

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Correct Answer » D Explanation

Ans:D. Metronidazole.

Pap Smear shows Trichomonas Vaginalis Infection.: Numerous organisms free and feeding on squamous cells .

Cytopathology of Trichomonas Vaginalis Infection

Features:

• Low power: grey blob with a nucleus, may be pear-shaped:

• Size: approximately 30 micrometres.

• Shape: usually oval, may have teardrop-shaped.

• Flagellum – hair-thin locomotive stucture, usu. barely visible at 200X – diagnostic feature.

Cytopathological associations:

• Acute inflammation (neutrophils), often marked – key feature at low power.
• Reactive squamous cells with:

1. Nucleoli,
2. Perinuclear halos, and
3. Moth-eaten cytoplasm; cytoplasm that has multiple vacuoles with star-like spaces.

Notes:

• Trichomonas is tricky – it is easy to miss if one is not suspicious, in the context of inflammation.

• May vaguely resemble a neutrophil:

1. Flagellum useful to differentiate.
2. Neutrophil has multiple lobulations of the nucleus.

• May be seen in association of Leptothrix.

1. Appearance: long, hair-like.
2. Size: ~0.5 x 20 micrometres.