Strongyloidiasis screening

Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections. Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk. Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach.

• Most fatal infections caused by S.stercoralis can be prevented by early detection and treatment of asymptomatic chronic infections.^[1][2][3]
• Screening is highly recommended to detect latent S.stercoralis infection before the start of chemotherapy or immunosuppression/steroid therapy in patients at risk.^[4]
• Repeated stool examination for ova and parasites or agar culture of stool may be the most appropriate approach.

• In the U.S., residents of the Southeast may be at risk for strongyloidiasis by growing up in an endemic area.
• Travelers and armed forces personnel may acquire infection during overseas trips to endemic areas (e.g., southeast Asia, Central and South America, and Africa).
• Refugees and immigrants from endemic areas
• Immunocompromised patients, especially on corticosteroid therapy, are the most vulnerable population at risk for developing disseminated disease.
• Efforts to diagnose and screen individuals who harbor S.stercoralis should be made for patients who are candidates for immunosuppressive (e.g., corticosteroid) therapy with relevant geographic history and peripheral eosinophilia.

• At least three ova and parasite examinations should be performed on separate days.

• An enzyme-linked immunosorbent assay (ELISA) for detecting serum IgG (Strongyloides antibody) against a crude extract of the filariform larvae of S.stercoralis is available and should be used as a screening test for strongyloides infection.
• However, because of cross-reactivity with other antigens, definitive diagnosis must also include identification of ova and parasites in stool specimens.