You Will Not Believe What We Found in the Urine Sediment

A 30-year-old male presented for routine urinalysis. The patient had no significant medical history but experienced intermittent low abdominal pain and dysuria prompting urinalysis. Laboratory investigations, including microscopic urine analysis (Table 1), were normal except for the presence of red blood cells (RBCs) without any apparent cause. Microscopic examination of the urine sediment revealed unusual bristled, arrow-shaped particles which did not resemble a biological entity. Further detailed examination showed the unexpected presence of insect fragments resembling hastiseta on the transverse segments (tergites) of the carpet beetle larvae (Fig. 1). Carpet beetles are commonly found in homes, but their presence in urine is an exceedingly rare phenomenon. We discuss the potential sources of contamination, clinical implications, and diagnostic challenges associated with this unusual finding. This case highlights the importance of considering unconventional etiologies when encountering atypical findings in clinical practice. By sharing this case with the clinical chemistry community, we aim to broaden knowledge and enhance diagnostic capabilities in the field of urinalysis. The patient’s microscopic urinalysis showing the carpet beetle larva hastiseta at 400× magnification. Patient’s macroscopic and microscopic urinalysis results. *According to the Canadian Urological Association Guidelines, microscopic hematuria is defined as greater than 2 RBCs/hpf on two microscopic urinalysis without recent exercise, menses, sexual activity or instrumentation. Abbreviations: Leu, leukocytes; Ery, erthrocytes; WBC, white blood cell; RBC, red blood cell; HPF, high power field. What are the possible sources of carpet beetle larvae hastiseta contamination in urine? Why should healthcare professionals and laboratorians be aware of the potential presence of carpet beetle larvae resembling hastiseta in urine sediment during microscopic analysis? What are the clinical implications and diagnostic challenges of finding carpet beetle larvae in urine? Carpet beetles (Order: Coleoptera, Family: Dermestidae) are household pests known for their ability to infest various materials, including carpets, clothing, and furniture (1). While these insects are relatively common in domestic settings, their presence within human bodily fluids, particularly urine, is extremely rare (2, 3). Canthariasis, also known as beetle disease, is a condition in which beetles temporarily infect the digestive tract and rarely the urinary tract through the direct ingestion of eggs or larvae, or by laying eggs on the urogenital opening (4). In the context of this case report, while the presence of carpet beetle larvae has been reported in cervical smears, their occurrence in male urine is considered quite unusual (5). Potential sources of exposure in this scenario are probably either by the larvae being already in the urinary tract system, or by contacting contaminated objects such cotton balls and hygiene products. In this case, the clinical significance of carpet beetle larvae parts in the urine remains uncertain. It is important to differentiate between incidental contamination and potential pathogenic effects. Identification of carpet beetle larvae in urine can be challenging during microscopic analysis. In fact, the larvae due to their unusual appearance can be easily mistaken for artifacts. Given the rarity of this finding in urine samples, it is crucial to raise awareness among healthcare professionals and laboratory technologists. Needless to say, accurate identification and interpretation of these unusual structures are vital for comprehensive diagnostic evaluations and appropriate patient management. Obtaining a detailed patient history, including exposure to contaminated environments, can also aid in establishing a possible source of contamination. The presence of carpet beetle larvae hastiseta in the urine of a 30-year-old male with microscopic hematuria raises questions about potential sources of contamination. In addition to considering contamination from diapers and feminine hygiene products, it is important to explore other potential modes of transmission, such as contamination through beetle eggs. Carpet beetles are known to lay eggs in various environments, including bedding, furniture, and carpets (1, 2). If the patient had been in contact with contaminated materials, it is possible that beetle eggs could have been inadvertently transferred to the urinary tract, resulting in the subsequent presence of larvae in the urine. Skin contact with contaminated surfaces and cotton-based clothing can serve as a potential route for the introduction of beetle eggs into the urinary tract system. Also, it is possible that urine is contaminated during or after collection. To further investigate this potential mode of transmission, it is crucial to gather information about the patient’s activities and exposures. Inquiring about recent contact with contaminated environments and assessing the patient’s hygiene practices and living environment can contribute to understanding the likelihood of exposure to beetle eggs or larvae. Considering the patient’s relationship status and sexual activity is also important. If the patient has a sexual partner, it is relevant to explore the partner’s overall health, as well as their exposure to potential contaminated environments. In this case, the patient had no other clinically significant findings such as rashes, dermatitis, or lymphadenopathy. Also, there was no history of asthma, reactive airway disease, or upper airway symptoms. The patient had not previously engaged in self-catheterization. However, it is important to note that in a follow-up visit the physician asked the patient about possibilities that may have contributed to the presence of the larvae parts in the urine. The patient informed about a recent purchase and use of a sex doll. The latter can be a potential source of contamination in this case. Additionally, in our follow-up investigation, there were no other instances of contaminated urine specimens collected from the same site or during the same timeframe, suggesting that the source of contamination is unlikely to be the urine containers, or to have been introduced during the specimen collection. Of note, a follow-up urinalysis was performed 2 weeks after the initial analysis and it was negative. Further research is needed to better understand the dynamics of carpet beetle larvae transmission in the human urinary tract. Consultation with the physician managing the patient and conducting a thorough literature review can provide additional insights into the potential modes of transmission and guide appropriate management strategies. Treatment options for infection of the urogenital tract by carpet beetle larvae are not well-established. Potential approaches include the removal of larvae, the use of antiparasitic medications such as ivermectin, and supportive management to alleviate discomfort (4). This case highlights the importance of considering unconventional etiologies when encountering atypical findings in clinical practice. By sharing this case with the clinical chemistry community, we hope to broaden our knowledge and enhance diagnostic capabilities in the field of urinalysis. In a subsequent patient consultation, the physician engaged in a follow-up discussion during which the patient disclosed that they had recently acquired a sex doll. This acquisition raised concerns as it could potentially have been contaminated with carpet beetle eggs or larvae, which might offer a plausible explanation for the presence of larvae in the patient’s urine. The manufacturing processes of such items, like sex dolls, often lack stringent regulations that guarantee hygiene and cleanliness. Interestingly, even in more tightly regulated industries, such as the production of diapers and other hygiene products, instances of eggs and larvae serving as sources of contaminants have been documented. Thus, while we could not definitively establish a direct link, it remains plausible that items like sex dolls could potentially serve as sources of contaminants in certain cases. Our primary objective in presenting this case study is to underscore the significance of not hastily dismissing unusual findings in urine sediments as mere artifacts. We emphasize the critical importance of consulting both colleagues and existing literature before reaching final conclusions when reporting test results. This is particularly crucial because, as demonstrated in this case, what might initially appear as an artifact could, in fact, turn out to be a biological entity. In terms of the case’s resolution, over the course of a few weeks, the patient experienced a complete recovery without the need for medical interventions. However, they were strongly advised to maintain strict personal hygiene practices to prevent potential future incidents. Healthcare professionals encountering new and unconventional findings, especially in urinalysis, should consider them carefully and seek as much consultation as possible. Carpet beetles (Dermestidae) commonly infest homes; however, are rarely found in human bodily fluids, particularly urine. Accurate identification and interpretation of carpet beetle larvae in urine are vital for comprehensive diagnostic evaluations. The presence of carpet beetle larvae in urine may indicate a potential source of contamination or infection in the urinary tract. Further research is required to determine the clinical implications and health effects associated with carpet beetle larvae in urine. Author Contributions: The corresponding author takes full responsibility that all authors on this publication have met the following required criteria of eligibility for authorship: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising the article for intellectual content; (c) final approval of the published article; and (d) agreement to be accountable for all aspects of the article thus ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved. Nobody who qualifies for authorship has been omitted from the list. Authors’ Disclosures or Potential Conflicts of Interest: No authors declared any potential conflicts of interest.

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