Image Challenge 6: Strongyloides stercoralis

The worms were identified as filariform larvae of Strongyloides stercoralis. Presence of this larvae in the respiratory tract is a manifestation of disseminated infection.

Subclinical infection with this worm may persist for decades through an autoinfection cycle in which there is low-level hematogenous migration from the gastrointestinal tract to the lungs and then, through reverse aspiration, back to the gastrointestinal tract.
When a patient with latent S. stercoralis infection is given corticosteroid therapy, a severe, life-threatening hyperinfection syndrome may occur; this syndrome is often associated with sepsis from enteric flora (probably related to worm migration across the intestinal mucosa).

Hence patients at risk for acquiring S. stercoralis infection should be identified, screened, and treated appropriately, before corticosteroid therapy.

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