Strongyloides Stercoralis on sputum microscopy As many suggested this was strongyloides stercoralis hyperinfection syndrome. Infection is initiated by infectious larvae (Filariform) penetrating the skin, (often soles of the feet) Larvae penetrate the skin + travel through the bloodstream to the pulmonary circulation. They penetrate and enter the alveolar space. Larvae are then expectorated (coughed up), traveling up through trachea and then swallowed. In the GI tract they mature into the adult worm The females produce eggs which are passed on into the stool. This whole cycle takes 2-4w. Unlike other parasites, the eggs hatch in the intestine. Infective larvae burrow through the intestinal mucosa and travel back to lung to complete this cycle again (autoinfection). This is quite unique to strongy. Pts w/ chronic strongy are generally asymptomatic or minimal symptoms: - GI: diarrhea, constipation, intermittent vomiting, and borborygmi - Derm: larva currens, pruritus, urticaria, and angioedema - Resp: dry cough, throat irritation, dyspnea, and wheezing Hyperinfection syndrome is caused by accelerated autoinfection, the result of an alteration in immune status. Classic culprits include steroids! In hyperinfection w see exacerbation of GI/pulm symptoms as there is increased larval migration within the organs normally involved in the autoinfection cycle. Larvae in stool/sputum is the hallmark of hyperinfection Dr. Ahmed Babiker @Ahmed_HBabiker #Strongyloides #Stercoralis #sputum #microscopy #clinical #strongyloidiasis #microbiology
