Case 23. Strongyloidiasis (66 y-o M)
         
    Gastric biopsy from a patient accompanying GI bleeding, anemia and hypoproteinemia    
         
   
Key words : 
Strongyloides stercoralis, autoinfection, disseminated strongyloidiasis, filarial larva    
         
   
opportunistic infection
   
     
 
     
Numbers of larvae surrounded by the eggshell are seen in the metaplastic gastric pit, indicating the state of hyperinfection (HE).   Egg-containing female adult worms are seen among the foveolar cells (HE). 
     
 
     
Life cycle of Strongyloides stercoralis
Note the presence of the parthenogenic parasitic stage and gametogenic free-living stage in the soil. Persistent autoinfection occurs through direct intraluminal transformation into the infective filarial larvae.
  Reference case 23A
Autopsied jejunum hyperinfected with mature female adults of S. stercoralis. Note severe mucosal inflammation and submucosal invasion of the filarial larva (HE). The latter indicates disseminated strongyloidiasis.
     
 
     
Reference case 23A
Autopsied jejunum hyperinfected with mature female adults of S. stercoralis. Cut surfaces of the adult females reveal the gut and maturing ova.
  Reference case 23B
Disseminated strongyloidiasis in adult T-cell leukemia (45 y-o M). Duodenal biopsy reveals marked inflammation with eosinophilia and shortening of villi (HE, lower power).
     
 
     
Reference case 23B
Disseminated strongyloidiasis in adult T-cell leukemia (45 y-o M). A filaria-type larva with granulated cytoplasm is seen in the inflamed duodenal lamina propria (HE, high power).
  Reference case 23C
Disseminated strongyloidiasis in AIDS in Thailand (32 y-o M). Sputum cytology demonstrates a filaria-type larva, indicating opportunistic systemic infestation with a poor prognosis (Papanicolaou).