A Case of Cholecystitis in which Rhabditiform Larvae of Strongyloides Stercoralis were detected by Duodenal Intubation

Abstract

A 37 year old male complaining of right hypochondralgia was hospitalized on August 17,1974. His previous doctor had suspected the presence of gallstones. He had lived in Kochi prefecture until he was 15 years of age. He then lived in Rio de Janeiro from 1952 to 1965. During this time he often walked barefoot. He has lived in Osaka since 1965. When examined on admission there was oppression and percussion tenderness in his r-hypochondral region. No other abnormalities were found.
Lab. data: WBC 7500 (Eosinophils: 12%)
Hb 16.7 g/dl
liver and renal functions: normal
Chest-X-P: n. p.
Upper GI-series: n. p.
Cholecystography: stone (-), contractivity: slightly hypokinetic
Examination of the duodenal fluid revealed Rhabditiform larvae only in his A-bile and leukocytosis in his B-bile. However, examinations of his stool samples by the direct smear method were always negative. The diagnosis was completed when Filaria-form larvae, a very distinctive form of strongyloides stercoralis, was found by the “test tube filter paper cultivation” method. The patient was treated with Pyrvinium pamoate (total dose: 3300 mg) for 5 days. During the treatment he complained of nausea and vomiting, but no abnormalities were found in the laboratory data. After this treatment, eosinophilia gradually decreased and the test tube filter paper cultivation resulted negative for 28 days. Although the patient seemed to be cured by this treatment, eosinophilia recurred 6 months thereafter and his stool culture again revealed Filariaform larvae.
Strongyloidiasis is prevalent mainly in the southernmost parts of Japan, especially the Amami Islands, and in other tropical and subtropical areas of the world. According to “Igaku-chuo-Zasshi”, a comprehensive Japanese medical publication, only 21 cases of strongyloidiasis were reported in Honshu Island between 1965 and 1974. Sixteen out of these patients were from the southernmost parts of Japan or had spent considerable time in tropical or subtropical areas.
The cause of infection, and the relationship between the strongyloidiasis and chole cystitis of this patient are discussed.