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            With between 30 and 100 million people in over 70 countries being infected with Strongyloides stercoralis, it is important that people are accurately diagnosed with strongyloidiasis and treated immediately to reduce the risk of hyperinfection syndrome which has an 87% mortality rate. Unfortunately, due to the low parasite load and irregular larval output, detection of S. stercoralis is missed in 70% of cases where single stool examination was used as the diagnostic tool. Stool examination is the typical diagnostic method, however, multiple stool examinations are often needed to detect the presence of the nematode. Multiple, unstandardized methods have been used to detect the presence of S. stercoralis larvae in stool samples; these methods include: direct smear of feces in saline–Lugol iodine stain, Baermann concentration, formalin-ethyl acetate concentration, Harada-Mori filter paper culture, and nutrient agar plate cultures. Examination of duodenal fluid is another diagnostic method that is 87% accurate, however, it is recommended only for children in need of rapid diagnosis as the test is invasive.  Eosinophilia is another indication of a S. stercoralis infection, but it is mild and unspecific. An ELISA test, a serodiagnostic test for S. strongyloides antibodies, has been found to be between 95 and 99% accurate, but unfortunately is only available in certain clinics. Due to the potential lethality of S. stercoralis infections, it is necessary to develop an accurate and standardized diagnostic test for this nematode, although not enough research is currently being done to evaluate and develop methods.

Reference:  

Eriksson CD, Steffens R, Siddiqui AA, Berk SL. Diagnosis of Strongyloides

             stercoralis infection. Clin Infect Dis 2001;33:1040 –7.

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