Filariform larvae of Strongyloides stercoralis-An unusual finding in ascitic fluid in an immunocompetent patient

Background: Strongyloides stercoralis, a nematode parasite in humans with free living and autoinfective cycles, is an asymptomatic infection of small intestine. Disseminated infection usually results due to increased worm burden in immune-compromised hosts. The adult female larvae remains embedded in the intestinal mucosa for years, producing eggs that develop into infective filariform larvae which on transmural intestinal penetration can reach the peritoneal cavity and produce ascites. Ascites with Strongyloides stercoralis infection in an immune-competent patient is extremely rare. Case Report: A 60 year old female presented with chief complaints of weakness, loss of appetite, alternating diarrhoea and constipation and frequent pain abdomen since 6 months with severe abdominal distension and marked pedal edema for 1 month. Diagnostic paracentesis showed numerous filariform larvae of Strongyloides stercoralis. Stool examination confirmed the presence of both rhabditiform and filariform larvae. The patient was found to be immunocompetent with HIV negative and HBsAg negative. Conclusion:Early detection of Strongyloides stercoralis may alter the often fatal course of infection