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From question on page 77

The diagnosis is strongyloidiasis hyperinfection. Duodenal biopsy (fig 1A, B) shows crypt hyperplasia and villous atrophy. Numerous rhabditiform larvae are seen within the crypts. There is mild to moderate infiltrate of polymorphs in the lamina propia.

Strongyloidiasis stercoralis is a cosmopolitan nematode commonly known as human threadworm. Chronic infection is often asymptomatic and may persist for years or even decades due to the ability of the worm for autoinfection. In an immunocompromised host, the organism multiplies, leading to overwhelming parasitic load (hyperinfection). The treatment of choice in the hyperinfection state is thiabendazole 25 mg/kg twice a day for 7–10 days.1

Strongyloidiasis stercoralis should be considered if at risk patients are commenced on immunosuppressive treatment and fail to improve or deteriorate. The role of duodenal biopsy in the diagnosis of this disease is not well established but it proved to be of great value in our case.


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