Monday, February 16, 2015

Case of the Week 337

The following case was generously donated by Lee.  The patient is a 26 year old male with advanced testicular cancer who developed abdominal pain after several rounds of immunosuppressive chemotherapy. A stool specimen submitted for bacterial enteric pathogens culture produced the following pattern on blood agar plate (BAP) and MacConkey (MAC) agar:

BAP





















MAC agar

































Wet preps from the plate:




8 comments:

Anonymous said...

strongyloides larvae

Adam said...

Looks like rhabditiform larvae of Strongyloides (note short buccal canal).

Anonymous said...

Very nice case Lee. I would say also Strongyloides stercoralis rhabditiform larvae.
First, this is the most commonly found rhabditiform larva in the stool in contrast to Ancylostoma which is only rarely found.
Second, the short buccal cavity and though it is not very clear, may be a genital primordium can be noticed in the last pictures.

Florida Fan

Paul said...

Looks like Strongyloides larvae. If you look closely, you can see the tracks on the plates.

Arthur Morris said...

Morphology seems consistent with Rhabditiform Strongyloides stercoralis with it's diminutive size and lack of sheath suggesting its L1, and its short buccal cavity. The track marks on the agar are also consistent with Strongyloides rather than Ancylostoma, which have a different movement pattern.

The history is particularly worrying, as it states that this patient underwent immunosuppressive therapy. Previously asymptomatic Strongyloides infections can develop into disseminated Strongyloidiasis if the patient becomes immunosuppressed, whereby a significant number of filariform (L3) enter the bloodstream from the GI tract and disseminate throughout the body, invading many organs and potentially causing huge damage. The timing of the abdominal pain soon after IST is consistent with this migration of L3's through the intestinal lumen, which could indicate the first stage of a hyperinfective syndrome.

Anonymous said...

Lee here,
The patient was tranferred to a tertiary care facility upon us notifying the ID doc that this patient had Strongyloides. The tracks on the bacterial culture media were classic for this. Of course it was noted late on a Friday afternoon, our cell phone cameras were on overload. Preps of stool were loaded. Keeping fingers crossed that all goes well for this young man..

Arthur Morris said...

Hi Lee

Many thanks for sharing this case and for the update, my fingers are crossed for his full and speedy recovery.

Arthur

Anonymous said...

Agree with Strongyloides stercoralis rhabditiform larvae.

Wan Hafiz