This week's case was generously donated by Dr. Alexander Fenwick and includes some beautiful images.
The following objects were seen in a sputum specimen from a patient living in Eastern Kentucky. This patient was receiving corticosteroid therapy for poorly-controlled COPD. Identification?
Gram stain (10x and 100x magnification)
Wet mount:
Strongyloides larvae from hyperinfection but seem a little short maybe so modest confidence on this site but in real life common things being common would be confident.
ReplyDeleteStrongyloides larva
ReplyDeleteNematodes larvae in the sputum bring to my mind two likely candidates, Strongyloides stercoralis and hookworm larvae. From the pictures, the larvae’s body appears fairly large but not elongated, the buccal cavity rather short, the last picture shows a genital primordium. The tails ends appear pointed. All clues converge on a diagnosis of Strongyloides stercoralis infection exacerbated by the steroid treatment.
ReplyDeleteFlorida Fan
Strongyloides stercoralis filariform larvae. Likely from hyperinfection syndrome, as this matches with the details of the patient being on corticosteroids. Not sure what each graduation of the eyepiece graticule is equal to, so would be unable to give a measurement based on these images.
ReplyDeleteStrogyloides stercorallis
ReplyDeleteOn closeup examination, the third picture shows a notched tail diagnostic for the filariform stage of Strongyloides stercoralis larvae.
ReplyDeleteFlorida Fan
Larva di Strongyloides stercoralis.
ReplyDeleteStrongyloides larvae, appears to be filariform larvae. This pulmonary infection may occur during larval migration.
ReplyDeleteStrongyloides larvae,usually exacerbated by steroids treatment.
ReplyDeleteIndeed, I think I see a notched tail in the two last pictures.
ReplyDeleteThis is never seen in e.g. hookworm larvae, so confirmatory for Strongyloides stercoralis filariform larvae.
Strongyloides and corticosteroids...always tricky!
I’ve just received word that I have this. I’ve never traveled to Thailand or other area it’s found in. They found it while screening for kidney donation. Anyone experienced this?
ReplyDeleteStrongyloides stercoralis autoinfective larvae from desiminated Strongylodiasis from in immunocompromised patient with corticosteroid drug.
ReplyDelete