What is the role of ELISA testing in the workup of strongyloidiasis?

Updated: Jun 20, 2019
  • Author: Pranatharthi Haran Chandrasekar, MBBS, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

A stool and serosurvey for S stercoralis conducted in a community in the Peruvian Amazon region found the ELISA test had a negative predictive value of 98% and is an excellent screening test for strongyloidiasis. [29] With the greatest accuracy for diagnosis of strongyloidiasis, [55] ELISA testing has been shown to detect the disease in approximately 85-90% of patients (82-95% sensitivity [56] ). However, its sensitivity may be lower in severely immunocompromised patients or in those with HTLV-1 infection, and ELISA cannot be used to differentiate between past and present infection, making the test less helpful in endemic areas. In addition, the anti-strongyloides antibody can persist for years even after successful treatment. In patients with eosinophilia, Strongyloides serology may be helpful. [57]

If ELISA results are positive, continue efforts to establish a parasitologic (microscopic) diagnosis because of cross-reactivity with other nematode infections (8-16%). This test is also useful for monitoring a patient's response to therapy (antibody titers decrease markedly within 6-12 mo of successful therapy).

ELISA can be performed at the National Institutes of Health (Laboratory for Parasitic Diseases) and the Centers for Disease Control and Prevention (CDC). The reliability of some serologies run by commercial laboratories is variable.


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