This week's case was donated by Dr. Francesca (Frankie) Lee. The following images are from Gram-stained and wet prep slides of a BAL from an immunocompromised patient.
What is your diagnosis? Are there any precautions you would institute for the samples in the laboratory?
Looks like Strongyloides stercoralis to me based on the source of the specimen and the appearance. Not engaged in lab work so will appreciate comments about the lab safety procedures.
ReplyDeleteS stercoralis larva for sure.
ReplyDeleteWow! A typical case of full blown invasive Strongyloidiasis. The Gram stain didn’t give us much detail for the identification. The wet mounts appear to show the notched tail of the infective filariform stage. The rhabditiform larvae have short buccal cavity. All clues fit an identification of Strongyloides stercoralis. Thought it has been said that filariform larvae cannot penetrate nitrile examination gloves, I would surely take extra precautions while handling such a specimen such as double gloves.
ReplyDeleteFlorida Fan
Larvae of Strongyloides stercoralis.
ReplyDeleteStrongyloides stercoralis, with a positive agar plate culture ! I would seal the petri dish, it's looking for a new host :-O
ReplyDeleteStrongyloides stercoralis, indeed! (This one I know!) BW in Vt
ReplyDeleteThe presence of threadworm larvae (Strongyloides stercoralis) in the bronchoalveolar lavage fluid of this immunocompromised patient is indicative of disseminated strongyloidiasis. This is a potentially lLIFE-THREATENING, MEDICAL EMERGENCY. The prescribing physician must be informed IMMEDIATELY, and the presence of a concurrent bacterial infection (whitish colonies on blood agar) must be reported so that the stewardship team can initiate appropriate management. (AMM)
ReplyDeleteThe collected samples must be considered as highly infectious due to the potential risk of transcutaneous or transmucosal (ocular) contamination. Biosafety measures for bronchoalveolar lavage fluid collection must be strictly adhered to. These BSL-2 safety level laboratory measures include, among other things, wearing masks, protective eyewear and handling samples under a biological safety cabinet (BSC) to avoid any inhalation or splashing. If necessary, additional infection prevention and control (IPC) measures must be instituted if the laboratory concerned does not meet these biosafety criteria.. (AMM)
ReplyDeleteDefinitely Strongyloides filariform larvae. In this case you cannot see the genital primordium, so you have to look the tip of the tail (notched) and the length of the esophagus (half the length of the larvae).
ReplyDeleteHow can we differentiate S. stercoralis and S. fuelleborni in this case?
We had a case of S. stercoralis a years back and went a little crazy with lab security measures (doble gloves, nobody could use the BSC after us before we clean it with alcohol and UV, biosafety apron with sleeves, the samples were innactivated before leaving the lab, etc). We were not exaggerating, this sample is really dangerous.
-HLCM fan
Strongyloides Stercoralis: Pulmonary manifestation of the larvae leads to bronchopneumonia. Immunosuppressive drugs predispose to hyper infection and it is reported that circulating strongyloides larva carry intestinal bacteria with them.
ReplyDelete