This week's case was kindly donated by Dr. Mike Mitchell and his laboratory. The patient is a middle-aged man with fever, intermittent cough, headache and mental status changes. He had a history of lymphoma and was receiving maintenance immunosuppressive chemotherapy. Of note, he had several episodes of bacteriemia and progressively worsening pulmonary infiltrates. He was originally from Sub-Saharan Africa but had been living in the United States for several decades.
The following are images from a duodenal aspirate:
What is your diagnosis?
6 comments:
? disseminated strongyloidiasis
All evidence points to a dissemination of S. stercoralis triggered by or exacerbated by the immuno-suppressive medication. There may be pulmonary parasitic invasion along with bacterial infection. The decades long dormant infection is also compatible with Strongyloides stercoralis.
Florida Fan
Strongyloides stercoralis
Strongyloides for sure, but could the other image show a disseminated fungal infection (hyphae)? I don't see any spores.
Is it possible for this microbe to have originated from Africa? Can microorganisms remain dormant for prolonged periods of time, including decades?
Hi Raul, yes, Strongyloides is one parasite that can remain dormant for decades, existing at low levels due to an autoinfection stage in its life cycle. While this may not cause problems, when patients become immuno compromised (such as this patient), the body is no longer able to control the low level of infection and it becomes quite dangerous. We called this hyper infection.
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