Strongyloides stercoralis in a bronchial washing specimen processed as conventional and Thin‐Prep smears: Report of a case and a review of the literature

Abstract

Strongyloidiasis is an opportunistic infection which may result in a fatal hyperinfection syndrome in immunocompromised patients. We report the case of a pulmonary infection with Strongyloides stercoralis in a 61-year-old male with a history of a long-term administration of corticosteroids. Cytologic examination of a bronchial washing specimen, processed both as conventional and as Thin-Prep smears, revealed an abundance of the typical larvae of Strongyloides stercoralis, amidst a cellular population comprising several acute inflammatory cells as well as bronchial epithelial cells with features of basal cell hyperplasia or regenerative atypia. To the best of our knowledge there is only one previous report describing Strongyloides stercoralis in thin-layer smears, and there are no previous studies comparing its morphology in conventional and thin-layer preparations.

Strongyloides stercoralis in bronchoalveolar lavage specimen processed as Prussian Blue Stain

“…3 S. stercoralis can be detected in BAL specimen by various staining methods, including Gram, Gomori-Grocott methenamine silver (GMS), Pap, and Diff-Quik stains. [4][5][6][7] Although Prussian blue stain is not routinely used to identify infectious organisms, it is able to demonstrate Strongyloides and thus may lead to an early diagnosis and initiation of life-saving therapy in situations like the presented case. In susceptible individuals with pulmonary hemorrhage and travel history to endemic areas, Prussian blue stained BAL specimen should be carefully examined for S. stercoralis larvae.…”

Severe Strongyloidiasis in Solid Organ Transplant Recipients: Should We Preventively Treat the Recipient, the Donor, or Both?

“…Strongyloidiasis is caused by a soil-transmitted helminth that is endemic in tropical and subtropical countries, 1 with rare cases described in southern Europe. 2,3 The infection starts when Strongyloides penetrates the intact skin and is followed by an invasive phase. 4 As Strongyloides has the ability to complete its life cycle without ever leaving the host, a chronic, mostly asymptomatic, life-long infection may occur, during which severe strongyloidiasis may develop in case of immunosuppression.…”

Rhabditiform larvae of Strongyloides stercoralis hatching in a bronchoalveolar lavage specimen

“…The life cycle of Strongyloides stercoralis is composed of parasitic and free‐living stages . The filariform larvae penetrate the skin to initiate the parasitic cycle, gain access via the circulation system to the respiratory and gastrointestinal tracts, and ultimately reach their final destination in the small intestine, where they develop into adults and release eggs . Rhabditiform larvae subsequently hatch and then either exit the body or develop into infective filariform larvae resulting in autoinfection .…”

“…1 The filariform larvae penetrate the skin to initiate the parasitic cycle, gain access via the circulation system to the respiratory and gastrointestinal tracts, and ultimately reach their final destination in the small intestine, where they develop into adults and release eggs. [1][2][3][4][5] Rhabditiform larvae subsequently hatch and then either exit the body or develop into infective filariform larvae resulting in autoinfection. [1][2][3][4][5] To our knowledge, we present the first case report of a clinical cytology specimen demonstrating the process of Strongyloides stercoralis rhabditiform larvae hatching in the respiratory tract and the first description of their eggshells.…”

“…[1][2][3][4][5] Rhabditiform larvae subsequently hatch and then either exit the body or develop into infective filariform larvae resulting in autoinfection. [1][2][3][4][5] To our knowledge, we present the first case report of a clinical cytology specimen demonstrating the process of Strongyloides stercoralis rhabditiform larvae hatching in the respiratory tract and the first description of their eggshells. 6 A 46 year old male with acquired immunodeficiency syndrome (AIDS) (CD4+ T-cell count 153/cu mm and viral load 270 cp/ml) and stage IV Burkitt's lymphoma developed neutropenic entercolitis after chemotherapy.…”