|Under a magnification of 128X, this photomicrograph revealed the presence of a number of Strongyloides sp filariform larval-staged organisms. Infective, third-stage filariform larvae (L3) of Strongyloides stercoralis are up to 600µm long. The tail is notched (see PHIL 1509, under higher magnification), and the esophagus to intestine ratio is 1:1. Infective L3 larvae are found in soil and invade the human host by direct penetration of the skin. They may be found in respiratory specimens during cases of autoinfection.|
Diagnosis rests on the microscopic identification of larvae (rhabditiform and occasionally filariform) in the stool or duodenal fluid. Examination of serial samples may be necessary, and not always sufficient, because stool examination is relatively insensitive. The stool can be examined in wet mounts:
- after concentration (formalin-ethyl acetate)
- after recovery of the larvae by the Baermann funnel technique
- after culture by the Harada-Mori filter paper technique
- after culture in agar plates
The duodenal fluid can be examined using techniques such as the Enterotest string or duodenal aspiration. Larvae may be detected in sputum from patients with disseminated strongyloidiasis.