Man with Raynaud’s disease who emigrated from Cambodia

endotracheal aspirate of a patient with pulmonary infiltrates

Question

A 46-year-old man with Raynaud’s disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An extensive evaluation was notable for the ground-glass infiltrates detected in the lower lobes on a computed tomographic scan of the thorax. Serologic tests and bronchoalveolar lavage were unrevealing. A specimen from a muscle biopsy showed necrotizing myopathy. Empirical therapy with oral corticosteroids was begun for treatment of an inflammatory condition that was presumed to be noninfectious. Four weeks after therapy was initiated, the muscle weakness and dyspnea were worse and there was progression of the pulmonary infiltrates. While the patient was waiting to undergo an open-lung biopsy, pulmonary hemorrhage, hypoxemic respiratory failure, and fulminant septic shock with Escherichia coli occurred.

This worm was identified in an endotracheal aspirate of a patient with pulmonary infiltrates. What is the infecting organism?

Ascaris lumbricoides
Clonorchis sinensis
Paragonimus westermani
Strongyloides stercoralis
Toxoplasma gondii

 

Show Correct.Answer

Correct Answer : Strongyloides stercoralis

Explanation :

The presence of this larva in the respiratory tract is a manifestation of disseminated infection with Strongyloides stercoralis.

Strongyloidiasis is primarily an infection of the small bowel by the filarial worm Strongyloides stercoralis.

Most infections are asymptomatic however immunosuppressed individuals may suffer gross infection.

Pulmonary features of strongyloidiasis are due to an eosinophilic pneumonitis.

Malabsorption and abdominal pain are due to a mild inflammation of the small bowel.

Massive autoinfection occurs in immunocompromised patients with invasion of gut, CNS and lungs.

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