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Disseminated Strongyloidiasis  with Hyperinfection syndrome:- A  first case at TUTH, Nepal.

There was a patient admitted in the nephrology ward, TU Teaching Hospital with respiratory distress. He was previously diagnosed as Nephrotic syndrome for which he was under steroid therapy.

His sputum sample was sent to Microbiology laboratory as he had respiratory symptoms. On Gram stain of his sputum sample, dead larvae of a helminth species were seen (fig. 1). We collected the repeat sputum sample of the patient and wet mount preparation was made which was observed under 10x and 40x of light microscope where we found actively motile larvae resembling larvae of Strongyloides stercoralis (fig. 2-11).

Then I forwarded the photographic evidence  to CDC, Atlanta for confirmation where CDC has confirmed as filariform larvae of Strongyloides stercoralis (indicated by the 1:1 ratio of esophagus to intestine and notched tail).

Patient’s stool sample was also collected which on microscopy revealed plenty of actively motile larvae of Strongyloides stercoralis (fig.12). The patient might had localized gastrointestinal strongyloidiasis which got disseminated after steroid therapy.

So, patients should be screened by routine stool examination for intestinal strongyloidiasis before starting steroid or any  immunosuppressive therapy to prevent death due to dissemination.

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Fig. 1 Gram stain showing dead larvae

 

 

 

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fig. 2 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 3 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 4 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 5 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 6 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 7 larvae of Strongyloides stercoralis under 40x of sputum sample

 

 

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fig. 8 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 9 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 10 larvae of Strongyloides stercoralis under 40x of sputum sample

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fig. 11 larvae of Strongyloides stercoralis under 40x of sputum sample

 

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fig.12 larvae on wet mount of stool sample of same patient

 

Thanks to CDC ( Atlanta),  Dr. Shusila, Dr. Neha, Dr. Mahesh, Rajshree, Santosh, Manoj, kamal and others member of Microbiology department for their role to make this diagnosis possible and a big thanks to Department of Nephrology for their support and guidance.

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