William was also kind enough to provide adults of this parasite, complete with more eggs (in utero and free). I've seen similar adult worms in concentrated stool specimens.
Can anyone put this whole picture together for us?
Tuesday, November 24, 2020
Case of the Week 615
In the spirit of the American Thanksgiving holiday, I'd like to present two related cases that were donated by two parasitologists in our wonderful parasitology community: George from Memorial Sloan Kettering and William Sears from the NIH. I'm thankful for many things, and among them are this generous and supportive group that inspires and educates me each week. In his case, George noted the following in a stool concentrate:
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Am going to guess hookworms but no idea how to weave that into Thanksgiving.
Thanks for doing this wonderful blog.
Eggs, adult females (last few pics), and rhabditiform larvae of Strongyloides stercoralis. I can see a short oesophagus and bulb in the adult females, but not sure if this is particurly diagnostic of the adult worms as it is in the rhabditiform larvae.
Wow! Looks like hookworm adult and eggs (looks like fertilized eggs in some of the pictures).
Strongyloides fulleborni?
What we see in the pictures are eggs, rhabditiform larva and gravid adult females. The seemingly short buccal cavity enable us to steer towards Strongyloides stercoralis. There was no evidence associated with non human primates to support an identification of Strongyloides fulleborni, another fact is that the eggs of this later one do not hatch within the host.
Florida Fan
There isn’t any clinical history provided. Strongyloides stercoralis eggs aren’t found alone in the stool. They hatch in the small intestine, unless the patient is on chemotherapy and rapidly shedding small intestine epithelium containing the eggs and rapidly passing it in stool they shouldn’t be found there. However given the case is from NIH and MSK that is a possibility. For Strongyloides fulleborni the egg is found in stool and diagnostic, but it occurs in Africa and is associated with primates but without travel history and animal exposure cannot definitely rule it out. The patient could also be coinfection with hookworms (eggs) and strongyloides stercoralis (larvae/adults). Just my thoughts.
If the sample isn’t preserved properly the eggs will hatch into larvae. So with Strongyloides fulleborni you can see eggs and larvae with unpreserved stool samples. For Strongyloides stercoralis this scenario might be seen in a cancer patient on chemo with SI mucosal shedding.
Wonderful case. It is obviously three females Strongyloides stercoralis/ fuellerboni contained numerous eggs in the uterus. Some eggs were released in the stool. Most eggs contain larva inside and the rhabditiform larva is present nest to the egg.
Guess this is hookworm as eggs are seen in fecal sample. Unpreserved sample lead to the hatching of larva? Since hookworm larva is not usually seen in stool sample.
Eggs present are at different stages of development. Some egg sizes appear larger than Strongyloides spp. eggs. The presence of rhabdidiform esophagus in adult worms opens the door to numbers of free living and plant parasitic nematode contaminants.
I don’t have a diagnosis, but I do have a story.
Once upon a time, while looking at a fecal flotation from a dog. I came across similar eggs and adult nematodes. Upon discussion with the owners, I discovered the dog had been eating rotted carrots from the garden. Consulting with our resident plant pathologist. We determined the worms were root knot nematodes (Meloidogyne). Root knot nematodes are common to many root crops which include SWEET POTATOES. A possible but improbable Thanksgiving connection.
Pearl Of Wisdom: Plant parasitic nematodes have an oral stylet (a wonderful diagnostic feature)
Strongyloides stercoralis
I am leaning towards spurious passage of a soil/plant nematode.
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