Monday, March 15, 2021

Case of the Week 630

 The following are images from a stool agar culture after 3 days of incubation at room temperature. The patient has persistent peripheral eosinophilia and mild intestinal complaints.

This appearance prompted further examination of the plate by light microscopy, which revealed the following (click on thumbnail for video):

What is your differential diagnosis based on this information?


Marc Couturier said...

Hookworm vs Strongyloides vs Trichostrongylus

Flood the plate with formalin, fix, and make a wet mount to identify the larvae to genus level.
Great video!

Anahelka said...

Strongyloides stercoralis, associated to eosinophlia.
Agar culture is a diagnostic method

Eagleville said...


TheOracle said...

Since we don't know how much time passed between the stool passage and its placement on the plate, hookworms, Strongyloides and Trichostrongylus must all be considered in our differential diagnosis. Another possibility could be Oesophagostomum, but it tends to give acute abdomen and it's not the case.

The video gives us some extra informations: we can see a high oesophagus/intestine ratio and maybe beadlike swelling on the tails' tips. Based on this my brains screams Trichostrongylus!

Flooding with formalin and wet mount shall give us a precise diagnosis.

Italian new fan!

Sam said...

Strongyloides? We don't provide stool culture for parasitic larvae in our laboratory. What is the agar? Is it easy to make? Can a basic nutrient agar be used? Just wondering in case we ever found Strongyloides or hookworm on microscopy. It would be interesting to see if we could grow them.

Anonymous said...

Strongyloides is the first diagnosis that comes to my mind, this said I still would perform the microscopy to confirm the identification.
Traditionally the feces culture had been done with activated charcoal at room temperature, Dr. Pritt please give us the agar culture procedure as it appears to be more beneficial since it’s easier to see the filariform or adult stages in vivo. Many thanks,
Florida Fan

Jose Q said...

Strongyloides match with the symptoms. This is an interesting case.

erletay said...

Koga plate for detection of Strongyloides stercoralis. As I see it works with other larvae too. Thank You very much! I've seen it in books only! Nice video !