Answer to CC #18

Case challenge #18 presented a 68 year old Asian female with HIV admitted for fever and SOB. Three days prior to admission, she developed watery diarrhea, approximately 5-6 BM a day. The work-up revealed 40% Eos and stool O&P with larval forms.


  • The correct answer is: Strongyloides Stercoralis!

    • General Information
      • Strongyloidiasis is a chronic parasitic infection of humans caused by Strongyloides stercoralis.
      • Transmission occurs mainly in tropical and subtropical regions but also in countries with temperate climates.
      • An estimated 30–100 million people are infected worldwide
      • Infection is acquired through direct contact with contaminated soil during agricultural, domestic and recreational activities.
      • Like other soil-transmitted helminthiases, the risk of infection is associated with hygiene, making children especially vulnerable.
    • Clinical Manifestations
      • Strongyloidiasis is frequently underdiagnosed because many cases are asymptomatic
      • Strongyloidiasis may cause intermittent symptoms that mostly affect the intestine (abdominal pain and intermittent or persistent diarrhea), the lungs (cough, wheezing, chronic bronchitis) or skin (pruritus, urticaria).
      • Infection may be severe and even life-threatening in cases of immunodeficiency.
      • Without appropriate therapy, the infection does not resolve and may persist for life.
    • Diagnosis
      • Most diagnostic methods lack sensitivity.
      • Locating juvenile larvae, either rhabditiform or filariform, in recent stool samples will confirm the presence of this parasite.
        • Ascaris, Necator, and Schistosoma will have eggs in the fecal smear, not larvae
        • Trichinella will have larvae in the muscle 
      • Other techniques used include direct fecal smears, serodiagnosis through ELISA, and duodenal fumigation.
    • Management
      • Ivermectin is the drug of choice, but is not available in all endemic countries.
      • Albendazole is also an option, but is considered less effective.

What species of Strongyloides-small

For more information, as Nico Barros or Fernando Woll, our resident Strongy scientists!