Now for this week's case, we have a very interesting submission from Dr. David Peaper. The patient is an elderly woman presenting with hematemesis. She underwent upper endoscopy and biopsies were taken from areas of erosion/inflammation. The biopsies were submitted for comprehensive vial culture, and the following were observed in the MRC-5 shell vials and traditional tube cultures.
9 comments:
Very fascinating case indeed. The concomitant presence of two stages of development of this nematode leads me to think of an autoinfection such as in the case of Strongyloides stercoralis. What is unusual is the large size of the big worm consistent with that of a free living adult, something not ususally seen in a clinical specimen, and the smaller worms being the L1 rhabditiform larvae. The short buccal cavity in the picture is very compatible with Strongyloides stercoralis L1 larva, the primordial genital is not that visible.
Florida Fan
Strongyloides stercoralis...I can't see the buccal cavity in the picture but I can see the primordial genital
Strongyloides stercoralis adult female and L1 rhabditoid larvae in the vídeo and clearly L1 in the second picture. Nice graphic material.
Strongyloides stercoralis, Larva allo stadio L1
Carlo
Strongyloides stercoralis
Strongyloides stercoralis rhabditiform larva in the picture while the video was the adult worm and larva of Strongyloides
Strongyloides stercoralis.
Different nematodes can be cultured this way, but as I think I can see a genital primordium in the larva on the photo, I’d go for S. stercoralis.
The buccal cavity is not clear from the photo, but I have the impression of seeing a bulbus, so that combined with the general aspect of the larva (relatively “short” and “thick”), my guess would be rhabditiform larva.
Video shows adult stage and larvae, which is not so uncommon as the culture serves to mimic ideal external environment, where free living adults can develop and sexually reproduce.
Strongyloides stercoralis! Adult and L1 larva :)
Strongyloides stercoralis, adult and L1 larvae on culture. We recently published a case where Strongy was found in the gall bladder, and it was only discovered because of track lines on blood agar plates cultured for bacterial etiologies!
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