Case of the Week 588

This week's case was donated by the very astute microbiology laboratory at the MetroHealth System who detected an important - but unexpected - finding. The patient is an elderly man on inhaled bronchodilators and steroids for persistent eosinophilic asthma who presented with fever, dry cough and shortness of breath. Reverse transcription PCR (RT-PCR) for the SARS-coronavirus-2 (cause of COVID-19) was negative, as was RT-PCR for influenza A and B viruses. However, blood cultures grew a number of bacteria including Gram-negative bacilli, and the following was noted in a stool ova and parasite exam. What parasite is present here?

Read Dr. Pritt's blog, Parasite Wonders, and submit your answers, comments, and questions. Also, visit her website, which hosts an archive of classic images from cases Dr. Pritt posted going back to 2007 (in an easy-to-search "A through Z" format) and also offers a flashcard feature.

An additional finding was seen on the sheep blood agar plate of the sputum culture:

Review of the sputum showed the following:

Answer to Case 588:

Strongyloides stercoralis

Bobbi Pritt, M.D. (@BobbiP)

Bobbi Pritt, M.D.

Bobbi Pritt, MD, MSc, is a Professor of Laboratory Medicine and Pathology and the Director of the Clinical Parasitology Laboratory at Mayo Clinic in Rochester Minnesota. She is also the Chair of the Division of Clinical Microbiology. Her research interests are in clinical parasitology, vector-borne diseases and the pathology of infectious diseases.