Question:medium
A patient who was on steroids presented with nocturnal cough and chronic urticaria. BAL stain was done. Identify the organism.
A patient who was on steroids presented with nocturnal cough and chronic urticaria. BAL stain was done. Identify the organism.
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In an immunocompromised patient on steroids with pulmonary symptoms, think of the nematode known for autoinfection and hyperinfection syndrome.
Updated On: Jun 23, 2026
- Strongyloides stercoralis
- Enterobius
- Ancylostoma
- Capillaria philippinensis
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The Correct Option is A
Solution and Explanation
Parasitology reasoning -- immunocompromised host:
Key clues:
- Patient on steroids (immunocompromised)
- Nocturnal cough (pulmonary involvement)
- Chronic urticaria (skin manifestation -- larva currens)
- BAL stain done (pulmonary larvae)
$\text{Strongyloides stercoralis}$ life cycle and hyperinfection:
- Unique autoinfection cycle: rhabditiform larvae in gut transform to infective filariform larvae
- Filariform larvae penetrate colon wall or perianal skin, reach lungs via bloodstream
- In immunocompromised patients (steroids, HIV, HTLV-1): massive autoinfection = Disseminated Strongyloidiasis
- BAL reveals filariform (L3) larvae
- Skin manifestation: larva currens (racing larva) -- linear urticarial track moving rapidly
Other helminthic infections do NOT cause hyperinfection in steroid-immunosuppressed patients in the same manner.
\[\boxed{\text{Strongyloides stercoralis}}\]
Key clues:
- Patient on steroids (immunocompromised)
- Nocturnal cough (pulmonary involvement)
- Chronic urticaria (skin manifestation -- larva currens)
- BAL stain done (pulmonary larvae)
$\text{Strongyloides stercoralis}$ life cycle and hyperinfection:
- Unique autoinfection cycle: rhabditiform larvae in gut transform to infective filariform larvae
- Filariform larvae penetrate colon wall or perianal skin, reach lungs via bloodstream
- In immunocompromised patients (steroids, HIV, HTLV-1): massive autoinfection = Disseminated Strongyloidiasis
- BAL reveals filariform (L3) larvae
- Skin manifestation: larva currens (racing larva) -- linear urticarial track moving rapidly
Other helminthic infections do NOT cause hyperinfection in steroid-immunosuppressed patients in the same manner.
\[\boxed{\text{Strongyloides stercoralis}}\]
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