Image 17:
This male in his 60s, from the Caribbean, was admitted with a nasopharyngeal cancer, with metastases to the spine for which he received corticosteroids and morphine. During a month long admission he developed significant unexplained anemia and severe constipation with intermittent ileus, thought due to his pain medication and spinal lesions. He then developed a cough with purulent sputum and confusion. A sputum culture plate had the appearance seen here.
Diagnosis:
An astute microbiology technologist noted the serpiginous tracts and brought it to the parasitology lab. Several drops of saline were pipetted onto the tract, aspirated and placed on a slide. Under the 22x22mm coverslip 22 filariform and rhabditiform Strongyloides larvae were counted. No eosinophilia had been noted in multiple examinations over the previous 3 years. This case can be called 'disseminated Strongyloidiasis' or hyperinfection. An agar plate approach to diagnosing stool Strongyloides larvae has been shown to be relatively sensitive, but is not as sensitive as a good Strongyloides serology.
