Haque A K, Schnadig V, Rubin S A, Smith J H
Department of Pathology and Radiology, University of Texas Medical Branch at Galveston.
Mod Pathol. 1994 Apr;7(3):276-88.
The distribution of pathologic lesions and the parasite burden of major organs were studied in seven patients with disseminated strongyloidiasis who were autopsied at the University of Texas Medical Branch (Galveston, TX). All patients were immunosuppressed and had additional bacterial, viral, and fungal infections; six patients had received cortisone therapy and one patient had AIDS. High Strongyloides burdens were noted in untreated patients or in those with a short period of treatment. The proximal small intestine and the lungs showed the heaviest parasite burden, with large numbers of filariform larvae found in both locations. The lungs showed persistence of larvae in all patients, in the absence of intestinal or extraintestinal infection; this suggests that the respiratory cycle may be more resistant to therapy than the intestinal cycle. In the intestines, filariform larvae were seen at all levels, but higher burdens were seen in the upper as compared to lower small intestine, and larvae were more concentrated in the proximal jejunum than in the duodenum. Autoinfection (i.e., filariform larval penetration) occurred more prominently in the distal small and proximal large intestine than in the distal colon. Most filariform larvae were found in the intestinal lymphatics and were highly concentrated in mesenteric and retroperitoneal lymph nodes; conversely, larvae were not found in the spleen and were found in very low density in the liver. These findings, in concert, suggest that during autoinfection in humans, the Stronglyloides larvae transverse lymphatics to the thoracic duct, then pursue a lymphohematogenous dissemination to the lungs where they penetrate the air spaces and ascend through the airways to reach the gut.
对在德克萨斯大学医学分校（加尔维斯顿，德克萨斯州）接受尸检的7例播散性类圆线虫病患者的主要器官病理损害分布和寄生虫负荷进行了研究。所有患者均免疫抑制，并有额外的细菌、病毒和真菌感染；6例患者接受了可的松治疗，1例患者患有艾滋病。在未经治疗的患者或治疗时间短的患者中发现类圆线虫负荷较高。近端小肠和肺显示出最重的寄生虫负荷，在这两个部位均发现大量丝状幼虫。在所有患者中，肺部均有幼虫持续存在，而无肠道或肠外感染；这表明呼吸周期可能比肠道周期对治疗更具抗性。在肠道中，各水平均可见丝状幼虫，但与小肠下部相比，小肠上部的负荷更高，且幼虫在空肠近端比在十二指肠更集中。自身感染（即丝状幼虫穿透）在远端小肠和近端大肠比在远端结肠更明显。大多数丝状幼虫见于肠道淋巴管，并高度集中在肠系膜和腹膜后淋巴结；相反，脾脏中未发现幼虫，肝脏中幼虫密度极低。这些发现共同表明，在人类自身感染过程中，类圆线虫幼虫通过淋巴管进入胸导管，然后通过淋巴-血行播散至肺部，在肺部穿透气腔并通过气道上升至肠道。
