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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The following patients should be investigated for strongyloidiasis:

  • travelers or people who migrate from an endemic area and develop the following within 3-4 weeks of travel:
    • persistent unexplained eosinophilia
      • should be investigated further in the first instance by repeating the test to confirm the result
      • other common causes (atopy, drugs) should be excluded by obtaining a carful history of the patient
      • present during the acute and chronic stages, but may be absent with dissemination (2)
    • gastrointestinal symptoms: nausea, vomiting, abdominal pain, bloating
    • pulmonary symptoms: fever, wheeze, persistent cough
    • cutaneous symptoms: larva currens, hives, or pustules

Further investigations carried out in patients include:

  • three stool samples for microscopy - collected on separate days
    • although the test has low sensitivity for detecting S stercoralis (around 50%) it is considered to be the gold standard for diagnosis
    • larvae usually appear in stools 3-4 weeks after dermal penetration.
  • blood test for S stercoralis serology
    • detects IgG to a filariform larval antigen

In patients with massive autoinfection the rhabditiform larvae are present in sputum and faeces.

Reference:

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