Kinjo T, Tsuhako K, Nakazato I, Ito E, Sato Y, Koyanagi Y, Iwamasa T
Department of Pathology, Ryukyu University School of Medicine, Okinawa, Japan.
Int J Parasitol. 1998 Feb;28(2):323-30. doi: 10.1016/s0020-7519(97)00162-8.
We describe here four cases of disseminated strongyloidiasis. In Okinawa, it has been reported that about 10% of the residents are infected with Strongyloides stercoralis, but disseminated cases are rare. Detailed histopathological examination revealed that the present four cases could clearly be separated into two groups, two acute cases and two subacute cases. The acute cases died rapidly due to extensive diffuse intra-alveolar haemorrhage in both lungs. However, there were no inflammatory infiltrates, abscesses or granulomas in the lungs. Worms were demonstrated in the alveolar spaces. No extensive bleeding was observed in any organs except the lungs. The acute cases could be diagnosed as severe diffuse intra-alveolar haemorrhage syndrome, but deposition of immune complex (parasite antigen and immunoglobulins) and complement C3c was not demonstrated in the alveolar wall and small vessels of the lung. The subacute cases exhibited no such extensive haemorrhage, but scattered microabscesses were found with sepsis. During the migration of the worms from the colon, enteric bacteria entered the circulation in the two subacute cases. The acute cases received steroid therapy before the dissemination of the worms, but the two subacute cases did not. Steroids might have influenced the Strongyloides stercoralis dissemination and/or the course of the disease.
我们在此描述4例播散性类圆线虫病病例。在冲绳，据报道约10%的居民感染粪类圆线虫，但播散性病例罕见。详细的组织病理学检查显示，目前这4例病例可明确分为两组，即2例急性病例和2例亚急性病例。急性病例因双肺广泛弥漫性肺泡内出血而迅速死亡。然而，肺内未见炎性浸润、脓肿或肉芽肿。在肺泡腔内发现了虫体。除肺外，其他任何器官均未观察到广泛出血。急性病例可诊断为严重弥漫性肺泡内出血综合征，但在肺泡壁和肺小血管中未发现免疫复合物（寄生虫抗原和免疫球蛋白）及补体C3c的沉积。亚急性病例未出现如此广泛的出血，但发现有散在的微脓肿伴败血症。在两例亚急性病例中，虫体从结肠移行过程中，肠道细菌进入了血液循环。急性病例在虫体播散前接受了类固醇治疗，而两例亚急性病例未接受。类固醇可能影响了粪类圆线虫的播散和/或疾病进程。
