Dr. Goswami Parth Rajendragiri
Pathology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I believe I have strongyloidiasis. However, it has not been confirmed. I have to wait two weeks for a duodenal biopsy. But in the meantime, my heart feels more and more strained. It feels like the parasite is connected directly to my heart and is often painful. I can see the outline of where the parasite is and where it has been because it leaves a thin white trail on my skin, just like “larvae current.” Right now, I am most worried about my heart because it feels so strained with multiple white trails around it. And when I push on the white lines, it hurts in my heart. Sometimes I get a burning sensation along where these lines are.The doctor prescribed me the tablet Ivermectin 12 mg for two days. I took them for three days, but still no effect. I am worried that I will get a heart attack soon because today, it felt like it almost stopped beating under strain. The hospital here wants to give saline by IV and do a CMP panel blood draw. They also prescribed antiinflammatory drugs but did not figure out the problem.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. Strongyloides is a parasitic infection that requires the following investigations for diagnosis. Do duodenal aspirate and examination for larva or ova in a laboratory, stool examination for ova or larva, sputum culture, if needed. Usually, it does not affect the heart, but the intestine or lungs can be affected. If heart pain is present in the chest area, EKG and chest X-ray can be done. I suggest taking tablets Ivermectin and Albendazole. However, please consult a specialist doctor, discuss with them and start taking the medications with their consent. With proper treatment, it can be treated. Take care. Hope this will help you.
Patient's Query
Hi doctor,
Thank you for the reply. The duodenal biopsy result will take two weeks, and I am rapidly feeling worse, so I took a sputum sample and put it under my microscope. Please let me know if any images (attachments removed to protect the patient's identity) look like a parasite, larvae, or eggs.
Hi,
Welcome back to icliniq.com.
No these images (attachments removed to protect the patient's identity) do not look like strongyloides. Meanwhile I suggest you get a routine stool micro examination by a pathologist near you.
Patient's Query
Hi doctor,
Thanks for the reply. Ok thanks I will do that.
Patient's Query
Hi doctor,
Thanks for the reply. A bunch of worms appeared in my stool. Here are photos of the two of them (attachment removed to protectthepatient's identity). Are you able to identify what kind of worms these are?
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. It is good that you are aware of your health. You must know that worms cannot be classified on gross examination. It can be tapeworm, hookworm, roundworm, or Strongyloides. For confirmation and classification, a stool routine microscopic examination is a must. In stool routine micro examination pathologist will prepare an iodine-stained slide and see it in the microscope. In most worm infestations, the tablet Albendazole 400 mg is usually prescribed. After two weeks, a repeat stool routine micro examination is done. Your duodenal biopsy report will also guide the doctor to do further management. So stool routine micro examination is needed to classify worms. Take care. Hope this will help you. Good luck.
Patient's Query
Hi doctor,
Thanks for the reply. I finally got a microscopic view of the worm, which has a distinctive shape. It is very long and very thin. I have these white dots that appeared on my skin, I put one on my microscope slide, and it looked like a cyst or egg. I put wormwood oil and clove oil on it. Then it burst open, and a worm came out, but it died in the oil. Please take a look and let me know what type of worm this looks like. I will still take this to a laboratory to confirm, but perhaps you have an idea. Note: The first picture is the thing, the egg or cyst that it came out of.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. Parasitic skin infection is known as cutaneous larva migrans. Hookworms can cause it, usually, that is, an Ancylostoma group. In the USA, Ancylostoma braziliense species is common. Another possible skin infection is filariasis. In the provided image (attachment removed to protect the patient's identity), definite species cannot be identified. Your stool routine micro examination and skin lesion microscopic examination in a nearby pathology laboratory are recommended. I suggest the following- 1. Take tablets Albendazole and Ivermectin to treat the parasitic infestation. 2. Apply topical Thiabendazole cream. 3. Take Benadryl syrup to relieve itching and inflammation. Consult a nearby physician to get a prescription and investigate with the routine microscopic examination at a nearby laboratory. Skin biopsy of lesion done if needed to do a further workup. Take care. Hope this will help you.
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Pathology
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