From the Guidelines
Strongyloides is typically checked with serological tests, stool examinations, and sometimes molecular tests, with the most common serological test being the enzyme-linked immunosorbent assay (ELISA) which detects antibodies against Strongyloides stercoralis 1.
Diagnosis of Strongyloides Infection
The diagnosis of strongyloidiasis involves a combination of clinical presentation, laboratory tests, and sometimes molecular tests.
- Serological tests, such as ELISA, are commonly used to detect antibodies against Strongyloides stercoralis 1.
- Stool examination includes direct microscopy, the Baermann concentration technique, and agar plate culture methods to identify larvae 1.
- Multiple stool samples are often needed due to intermittent larval shedding.
- PCR testing of stool or other specimens can also be used for detection.
Importance of Testing
Testing is particularly important for immunocompromised patients or those who will receive immunosuppressive therapy, as they risk developing severe, potentially fatal hyperinfection syndrome if infected with Strongyloides 1.
- Screening is recommended for individuals from endemic areas before starting immunosuppressive treatments.
- Blood eosinophilia is a common finding in patients with S. stercoralis infection, though it is not present in all patients 1.
Treatment and Management
Treatment of strongyloidiasis is with ivermectin or albendazole, and risks and management of other opportunistic infections are well-covered in the ECCO guidance 1.
- For patients with hyperinfection syndrome or disseminated disease, larvae may be found in sputum, bronchoalveolar lavage fluid, or other body fluids.
- It is essential to seek specialist advice for the treatment and management of strongyloidiasis, especially in immunocompromised patients or those with severe infections 1.
From the Research
Diagnosis of Strongyloidiasis
The diagnosis of strongyloidiasis, an intestinal parasitic disease caused by Strongyloides stercoralis, can be made through various methods, including:
- Microscopic observation of larvae in stool samples, although this method has low sensitivity 2, 3, 4, 5
- Agar plate culture method, which is considered more sensitive and useful for diagnosis and evaluation of the eradicating effect 2, 6
- Baermann method, which can be modified to improve its efficiency 3
- Serological tests, which have demonstrated higher sensitivity, although some authors have concerns about their specificity 4, 5
- Molecular diagnostic methods, which are currently available in a few referral centers as in-house techniques 4
Methods for Detecting Strongyloides
The following methods can be used to detect Strongyloides:
- Direct smear test 3
- Agar culture plate method 2, 3, 6
- Baermann method and its modification 3
- Kato-Katz technique, although it is inadequate for S. stercoralis detection 4
- Concentration methods, which have better but still unsatisfactory sensitivity 4
- Serological tests, such as the luciferase immunoprecipitation system technique and ELISA coproantigen detection 4, 5
- Molecular diagnostic methods, which are currently available in a few referral centers as in-house techniques 4