What Does This Microscopic Picture Of The Sputum Indicate?

Posted on Fri, 1 Jul 2016

Question: I have been diagnosed with brugia malayi ( filiarisis ) ..... although my eosinophil count is just slightly above normal, I have been having very odd symptoms like heavy lung secretions..... major unilateral migraines....eye floaters....arthralgia...abdominal pain..urinary troubles.. My final diagnosis was mansonella perstans which was just based on symptomology and possibility.... I have been told it could also be strongyloides, which could fit a little more the picture....I have done multiple antibiotics treatment ( minocycline 6 weeks )...... ivermectin single doses here and there..... eosinophilia counts go a little down and then come back up few month later... could it be strongyloides ??? I have a microscopy picture taken from my sputum which shows a weird body......

Answered by Dr. Tushar Kanti Biswas (7 hours later)

Brief Answer:
?Disseminated Strongyloidiasis

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It appears that you are having disseminated strongyloidiasis, as microscopic picture taken from sputum goes in favour of Strongyloides larvae. To confirm you can undergo enzyme-linked immunosorbent assay for serum antibodies to antigens of Strongyloides It is a a sensitive method for diagnosing Strongyloidiasis. Strongyloidiasis also can cause eosinophilia and intermittent epigastric pain.
I would suggest also screening for HIV in view of suspicion of disseminated Strongyloidiasis though it is more common with human T cell lymphotropic virus type 1 infection and less common with HIV-1.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Tushar Kanti Biswas (9 hours later)

Hi,

Thank you for your answer. HIV testing was negative. What is the proper treatment for disseminated strongyloidasis, and what is the prognosis or problems linked with lymphotrophic virus ? Is this treatable ? What could i do ? Thank you.

Answered by Dr. Tushar Kanti Biswas (21 minutes later)

Brief Answer:
?Disseminated Strongyloidiasis in immunocompromised host

Detailed Answer:
For disseminated strongyloidiasis, treatment with Ivermectin should be extended for at least 5–7 days or until the parasites have been eradicated (not single doses here and there ). In immunocompromised hosts, the course of Ivermectin should be repeated 2 weeks after initial treatment.

In immunocompromised hosts, large numbers of invasive Strongyloides larvae can disseminate widely and filariform larvae can be obtained in sputum samples and is a frequent complication of infection with human - T cell lymphotropic virus type 1 (HTLV-1),a Deltaretrovirus like HIV (Lentivirus).

HTLV-1 infection is treated with antiretroviral drugs ( multidrug chemotherapy program induces complete responses in about one-third of patients).

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Tushar Kanti Biswas (44 minutes later)

Can i transmit htlv and strongyloides ??? what are the typical complication for htlv ? is it possible to disseminated strongyloides and not htlv ? and what type of test is used to diagnose htlv-1 ? thank you.... can

Answered by Dr. Tushar Kanti Biswas (1 hour later)

Brief Answer:
?Disseminated Strongyloidiasis ?co-infection with HTLV-1

Detailed Answer:
One can transmit HTLV-1 to other through sexual activity, more commonly from men to women; and through the blood—via contaminated transfusions or contaminated needles but no direct transmission of Strongyloide stercoralis from one person to other, is possible .

Complications of HTLV-1 infection-HAM (tropical spastic paraparesis), adult T cell leukemia/lymphoma (ATL),autoimmune diseases like uveitis, dermatitis, pneumonitis, rheumatoid arthritis, and polymyositis.

The presence of HTLV-I infection can be detected by a blood test(serum for HTLV-I antibodies).

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Tushar Kanti Biswas (1 hour later)

Is it possible to have disseminated strongyloides infection without htlv ?

Answered by Dr. Tushar Kanti Biswas (5 hours later)

Brief Answer:
Disseminated Strongyloidiasis

Detailed Answer:
Strongyloidiasis is normally constrained by unknown factors of the host’s immune system.
Disseminated Strongyloidiasis is usually complication of infection with human
T cell lymphotropic virus type 1, and less commonly with HIV-1 co-infection.

Disseminated Strongyloidiasis can also occur in immunocomprmised state without HTLV-1 or HIV infection e.g. in lowering of host immunity, especially with glucocorticoid therapy and much less commonly with other immunosuppressive medications (cytotoxic/anticaner drugs).

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.

Above answer was peer-reviewed by : Dr. Raju A.T