Advances in the Diagnosis of Human Strongyloidiasis

Abstract

Strongyloidiasis is an intestinal parasitic infection that is particularly relevant in immunosuppressed patients because it can cause severe disseminated disease. This review discusses the recent advances in the diagnosis of strongyloidiasis. We suggest clinical and epidemiologic criteria for the diagnosis and screening of strongyloidiasis, taking into account different epidemiologic contexts. The state of the art of the diagnosis of strongyloidiasis is discussed including parasitologic methods that are commonly used despite having low sensitivity; serology, which has demonstrated better sensitivity (with some exceptions such as travelers or immunosuppressed patients), and molecular biology methods, which have virtually 100 % specificity. Finally, we discuss different strategies to follow up patients after treatment, highlighting the importance of having accurate and reliable follow-up markers when assessing treatment efficacy both in a clinical and research context.

Novel approaches to the diagnosis of Strongyloides stercoralis infection

“…Clinical clues indicating S. stercoralis infection are poor and nonspecific [14]. What matters more on an individual basis is to optimize the negative predictive value of the diagnostic approach; therefore, highly sensitive tests are needed.…”

“…Serological methods are the most sensitive available diagnostic tools [13,14]. A variety of antigens have been used to develop serological tests.…”

“…The choice of the latter depends on local availability, and clear evidence supporting the use of a molecular method [52][53][54] rather than a 'traditional' one is still lacking. A potential alternative to excess testing might be presumptive treatment, as postulated by some [14], considering that the treatment agent of choice, ivermectin, is generally well tolerated. The costeffectiveness of the two competing approaches has yet to be evaluated [14].…”

“…A potential alternative to excess testing might be presumptive treatment, as postulated by some [14], considering that the treatment agent of choice, ivermectin, is generally well tolerated. The costeffectiveness of the two competing approaches has yet to be evaluated [14]. We think that presumptive treatment is justified if sensitive diagnostic tools are not available, or, even if they are and the results are negative, when a potentially exposed patient is symptomatic and other causes have been reasonably excluded.…”

“…Alternative methods, from serology to molecular biology, have been developed and evaluated during the past few years [14].…”