Step 3: Suggested diagnostic and empiric management approach based on identified risk category (Step 1) and clinical syndrome (Step 2).
| Risk category (as per Step 1) | Suspected clinical syndrome (as per Step 2) | |||
|---|---|---|---|---|
| Asymptomatic ± eosinophilia1 | Simple intestinal strongyloidiasis | Mild hyperinfection syndrome | Disseminated strongyloidiasis | |
| High | Send appropriate specimens for diagnostic testing2 (Moderate risk) |
Empiric treatment while awaiting diagnostic testing (High risk) |
Empiric treatment while awaiting diagnostic testing (High risk) |
Empiric treatment while awaiting diagnostic testing (High risk) |
| Moderate | Send appropriate specimens for diagnostic testing (Moderate risk) |
Send appropriate specimens for diagnostic testing (Moderate risk) |
Empiric treatment while awaiting diagnostic testing (High risk) |
Empiric treatment while awaiting diagnostic testing (High risk) |
| Low | Send appropriate specimens for diagnostic testing (Low risk) |
Send appropriate specimens for diagnostic testing (Low risk) |
Send appropriate specimens for diagnostic testing (Low risk) |
Send appropriate specimens for diagnostic testing (Low risk) |
| Very low | Screening not recommended. Consider alternate diagnosis (Very low risk) |
Screening not recommended. Consider alternate diagnosis (Very low risk) |
Send appropriate specimens for diagnostic testing (Very low risk) |
Send appropriate specimens for diagnostic testing (Very low risk) |
1 This includes asymptomatic individuals undergoing planned immune suppression.
2 In the rare circumstance where the patient is deemed high risk for strongyloidiasis and immunosuppression cannot await definitive diagnostic testing, we recommend empiric treatment with two doses of ivermectin as outlined in Step 4 below.