Eosinophilia is usually present, unless the patient is immunosuppressed. Overwhelming infection in untreated immunosuppressed persons can be fatal. Diagnosis Stool microscopy may reveal the rhabditiform larvae of S. stercoralis . These larvae, which have a short buccal capsule, can be infrequently detected despite multiple investigations. Furthermore, unless high power is used, Strongyloides larvae can be difficult to distinguish from hookworm larvae, which have a longer buccal capsule.
Serology can be helpful in confirming the diagnosis.
If strongyloidiasis is suspected, empiric treatment should be given. Ivermectin has recently been licensed in the United States and is now the drug of choice for strongyloidiasis. This newly available drug has far fewer adverse effects than thiabendazole. S. stercoralis can survive 40 years or more in a human host. In fact, strongyloidiasis has been found in U.S. military veterans who served in Southeast Asia during the 1960s.