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Old 10-08-2012
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Arrow Billy Step 1 Questions # 14

A 28-year-old woman from Venezuela with a history of rheumatoid arthritis develops painful swelling of her hands and
feet. She is treated with corticosteroid therapy. A month later, she develops profuse, watery diarrhea along with fever and
cough. On examination, she has a temperature of 37.3°C. Laboratory studies show hemoglobin, 13.5 g/dL; WBC count,
12,900/mm3; and platelet count, 242,000/mm3. The WBC differential count shows 59 segmented neutrophils, 5 bands, 16
lymphocytes, 8 monocytes, and 12 eosinophils. Microscopic examination of a stool specimen shows ova and small rhabditoid larvae. Similar larvae are present in a sputum specimen. Which of the following infectious diseases is most likely to produce these findings?


□ (A) Cysticercosis
□ (B) Onchocerciasis
□ (C) Schistosomiasis
□ (D) Strongyloidiasis
□ (E) Trichinosis
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Old 10-08-2012
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D) Strongyloiasis.

Disseminated infection due to immune suppression by corticosteroids!
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Most likely D
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Old 10-08-2012
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□ (D) Strongyloidiasis
????
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One day i will infect these microbes and they will search for "Anti-MEbiotic"....
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Hyperinfection syndrome caused by (D) Strongyloidiasis.
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Strongyloides stercolaris
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Old 10-09-2012
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Correct Answer D is correct

The rhabditoid larvae of Strongyloides stercoralis can become invasive filariform from autoinfection in
immunocompromised hosts, so-called “hyperinfection” with involvement of multiple organs. Immunocompetent hosts
typically have only diarrhea. Parasites, particularly worms, crawling through tissues incite a marked eosinophilia.
Cysticercosis from eating uncooked pork can result in the release of larvae that penetrate the gut wall and disseminate
hematogenously, often settling in gray and white cerebral tissue, where they develop into cysts. Onchocerciasis occurs as
a result of infection with the filarial nematode Onchocerca volvulus and leads to formation of a subcutaneous nodule.
Schistosoma mansoni or Schistosoma japonicum infections have adult female worms in the portal venous system that
release eggs that can produce hepatic fibrosis; Schistosoma haematobium worms live in veins near the bladder and
release eggs that result in hematuria. Eating infected meat, typically uncooked pork, can lead to trichinosis; Trichinella
encysts in striated muscle to produce fever and myalgias
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