Answer to Case 651

Answer to theParasite Case of the Week 651:Strongyloidessp. rhabditiform larvae, as evidenced by the short buccal cavity and genital primordium. ALSO in this interesting case are unembryonated and fully embryonated eggs. Eggs are NOT usually shed in the stool inStrongyloides stercoralisinfection. So how do we explain these findings? Are theseStrongyloideseggs? Or something else? Is there a mixed infection here?Based on my own interpretation and your comments, I ' ve come up with the 5 possible scenarios to explain the findings in this case:Scenario 1. Both the larvae and eggs are those ofS. stercoralis.As mentioned above,S. stercoralis eggs are not usually shed in stool. However, eggs may rarely be seen in very heavy cases of strongyloidiasis, such as our previous Case of the Week 615 which showed larvae, adults and eggs containing fully embryonated larvae. This scenario would mean that this patient has a potentially serious infection with heavy diarrhea, resulting in passage of eggs before they can hatch in the bowel. As mentioned by Anonymous, it would be helpful to inquire about signs and symptoms of respiratory tract involvement, and if present, examine the sputum forS. stercoralisfilariform larvae. Simiarly, Nema suggested obtaining a complete blood count to assess for peripheral eosinophilia, which is commonly seen in cases of hyperinfection.Scenario 2. We have a MIXED infection, with S. stercoralislarvae (not eggs) AND hookworm eggs. The h...
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