| A |
DrVirgo, dr.wad, lq2006, vibrio, nyimalay, drshvetasm, khiladi, Drtweetie |
8 |
67% |
| B |
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0 |
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| C |
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| D |
CocaCola, aspire, Justice, inkspot |
4 |
33% |
| E |
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| Author | 9 Posts |
Justice
Forum Fanatic
Topics: 101
Posts: 1,970
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A 45-year-old man with known HIV infection for many years is transferred from a community hospital for additional management of pneumonia. He is a migrant worker who was born in Mexico but spent most of his life in rural Georgia. The patient has not received antiretroviral therapy and has no history of AIDS-related complications.
An admission chest radiograph shows bilateral interstitial pulmonary infiltrates consistent with Pneumocystis carinii pneumonia. Admission arterial blood PO2 is 42 mm Hg with the patient breathing room air. Intubation and mechanical ventilation are required shortly after transfer. He is treated with intravenous trimethoprim/sulfamethoxazole and oral prednisone in standard doses, but his clinical condition deteriorates and hypoxemia worsens. An induced sputum specimen for P. cariniiis negative by direct fluorescent antibody stain, but the specimen was of poor quality. Bronchoscopy is performed, and microscopic examination of bronchoalveolar lavage fluid is shown. Which of the following pathogens is most likely causing this patient’s current findings?
A. Ascaris lumbricoides
B. Pneumocystis carinii
C. Taenia solium
D. Strongyloides stercoralis
E. Cryptosporidium parvum
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| DrVirgo
Forum Hero
Topics: 1085
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A. Ascaris lumbricoides
-Mexico and -thats what the picture looks like
-but I'm not 100% sure.
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| peter90036
Forum Elite
Topics: 28
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heh thats what i'd chose, but its probably not 
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| spmvj
Forum Newbie
Topics: 3
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In immunocompromised pt..so i think strongyloides
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| CocaCola
Forum Guru
Topics: 35
Posts: 908
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??? really bad in parasitology but it look slike strongyloides
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| guangyu
Forum Elite
Topics: 29
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A
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| Jcala
Forum Junior
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A
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| cool doctor
Forum Junior
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I think its strongyloides
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| Justice
Forum Fanatic
Topics: 101
Posts: 1,970
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The correct answer is D
This patient has Strongyloides stercoralishyperinfection. Strongyloidiasis is a helminthic infection that causes chronic intestinal infection in normal hosts. For patients with various immunodeficiency disorders such as AIDS, infection withS. stercoralis can cause severe disease. In such patients, eggs laid by adult worms hatch within the gut and release filariaform larvae that can “autoinfect” the host. This results in disseminated bacterial infections secondary to carriage of gut bacteria to sterile sites and/or massive invasion of various organs (usually the lungs) by the larvae themselves, resulting in severe respiratory compromise. Most HIV-infected patients withS. stercoralis hyperinfection have late-stage disease. A low circulating eosinophil count (eosinopenia) is thought to be a poor prognostic finding. In general, the prognosis in this setting is poor.
Ascaris lumbricoides helminths are macroscopic and are not encountered in this setting. Pneumocystis carinii organisms certainly do not look like the parasites shown.Cryptosporidium parvum is a nonhelminthic parasite that causes profound diarrhea in AIDS patients.Taenia solium is the pork tapeworm whose major extraintestinal complication is focal brain lesions (cysticercosis).
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