What is the role of fluid analysis 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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In hyperinfective and disseminated Strongyloides infection, larvae can be recovered from extraintestinal sites, including sputum, bronchoalveolar fluid, and in some cases, cerebrospinal fluid (CSF), urine, semen, ascites, gastroesophageal biopsy, and skin biopsy. In these cases, sputum examinations, bronchial washings, and bronchoalveolar lavages (BALs) frequently reveal filariform and/or rhabditiform larvae.

When observing the agar plate of sputum cultures, the microorganisms that are part of the normal respiratory flora may be found outside the area of streaking as groups of colonies arranged in a characteristic pattern. This laboratory phenomenon is a result of migrating larvae on the agar plates, and, in an appropriate clinical setting, is considered diagnostic of S stercoralis infection.

Perform a lumbar puncture if central nervous system (CNS) involvement is suspected. Perform CSF analysis (elevated protein levels, decreased glucose levels, pleocytosis with neutrophilic predominance) to evaluate for acute bacterial meningitis. A Gram stain may exhibit gram-negative rods or, rarely, gram-positive cocci in chains (Enterobacteriaceae, Streptococcus species). A wet mount preparation may reveal S stercoralis larvae.

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