Step 2: Define suspected clinical syndrome.

Suspected clinical syndrome	Appropriate diagnostic test	Appropriate diagnostic specimen
Asymptomatic ± eosinophilia (This would include asymptomatic individuals undergoing planned immune suppression.) (Very low risk)	• Serology • Stool ova and parasites (O&P) examination	• Serum • SAF4-preserved stool specimen
Simple intestinal strongyloidiasis1 (Low risk)	• Serology • Stool O&P examination	• Serum • SAF-preserved stool specimen
Mild hyperinfection syndrome2 (Moderate risk)	• Serology • Stool O&P examination • Sputum O&P examination • Agar plate culture	• Serum • SAF-preserved stool specimen • Fresh sputum in sterile container • Fresh stool/sputum for agar plate culture
Disseminated strongyloidiasis3 (High risk)	• Serology • Stool O&P examination • Sputum O&P examination • Urine O&P examination • CSF5 O&P examination • Tissue O&P examination • Agar plate culture	• Serum • SAF-preserved stool specimen • Fresh sputum in sterile container • Urine in sterile container • CSF in sterile container • Tissue, paraffin-embedded or unprocessed • Any fresh specimen as above for agar plate culture

¹ Characterized by weight loss, abdominal discomfort and loose stools, with or without eosinophilia.

² Symptoms of intestinal strongyloidiasis plus respiratory symptoms (cough, wheezing, dyspnea) with or without immunosuppression. (corticosteroids, HTLV-1 infection, malignancy, non-steroidal immunomodulating agents) and absence of signs of systemic toxicity or sepsis; all persons shedding larvae of Strongyloides should be screened for intercurrent HTLV-1 infection.

³ Severe clinical syndrome characterized by Gram-negative or polymicrobial sepsis and/or meningitis, with evidence of end-organ failure, including acute renal failure, acute respiratory distress, impaired consciousness, coma.

⁴ SAF = Sodium acetate-acetic acid-formalin

⁵ CSF = Cerebrospinal fluid