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mash
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06/24/04 - 09:14 AM

A renal transplant patient was admitted for graft rejection and pneumonia. A routine evaluation of his stool showed rhabditiform larvae. Subsequent follow-up revealed similar worms in his sputum. He had no eosinophils in his peripheral circulation. Which of the following is the most likely organism?

A. Necator
B. Hymenolepsis
C. Ascaris
D. Loa loa
E. Strongyloides

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Renegade
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06/24/04 - 10:26 AM

Hmm... graft rejection? So was he immunocompromised because of transplantation?
I don't remember about Hymenolepsis and Necator, but during the Strongyloides superinfection stage you can find its worms in sputum... If I remember correctly, worms in sputum are rare, and all the non-Strongy were advanced conditions of GIT worms, like when Ascaris manages to climb all the way up to the mouth... :shock:

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mdwannabe
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06/24/04 - 03:20 PM

Strogeloides Srecoralis.. :-)

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mdwannabe
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06/24/04 - 03:24 PM

sorry for the spelling :-)

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rida
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06/24/04 - 04:15 PM

But wouldn't an infection with strongyloides cause an increase in eosiniphilia?

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06/25/04 - 01:38 AM

"rida" wrote:
But wouldn't an infection with strongyloides cause an increase in eosiniphilia?

It should, shouldn't it? That remains to be explained...
Anyone know why? Maybe he was very immunocompromised..?

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Sakaki-
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06/25/04 - 01:43 PM

I guess that it must be an immunocompromised state that prevents eosinophils from appearing.

rida
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06/25/04 - 01:51 PM

mash is the answer strongyloides???

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asmi
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06/25/04 - 01:59 PM

Yes stongyloides stercoralis

Yes Rida ,it causes esoinophilia too .

http://www.emedicine.com/emerg/topic843.htm

mash
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06/25/04 - 02:03 PM

#10

yeah, it is strongyloides..
eosinophilia present in the normal host is lost in the immunocompromised hyperinfected patient.

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rida
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06/25/04 - 02:06 PM

#11

thanx asmi and mash.

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bactitech
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08/27/04 - 11:26 PM

#12

The key word in the question is "rhabditiform larvae." I've done O&P exams for over 20 years and have never heard of these larvae associated with any other parasite except Strongyloides.

I saw a plate from a sputum culture once where the larvae moved across the plate and tracked the bacteria behind it. There were weird little squiggles everywhere. It was actually pretty gross.

It's nice to see eosinophilia, but it doesn't always happen.

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