Table 3 Advantages and limitations of each technique for Strongyloides stercoralis detection

Parasitological

•Lower cost compared to immunological and molecular techniques

•Easily implementable in a field setting

•Require increased sampling for higher sensitivity due to irregular larva output or asymptomatic patients

•Possible misdiagnosis with hookworms due to similar morphology

•Require live larva

•Risk of S. stercoralis contamination when APC is used

Immunological

•Higher sensitivity than parasitological and molecular techniques

•Not limited by the larval output

•Able to detect other pathogens through multiplex assays

•Possible to detect other biological materials such as breast milk and saliva

•Potential for cross-reactivity with other helminthiases

•Persistence of antibodies renders the technique unable to distinguish between past and present infections (especially in endemic areas)

•Lowered sensitivity for immunocompromised host

Molecular

•Higher sensitivity than parasitological techniques (direct examination, spontaneous sedimentation, or Kato-katz)

•Higher specificity than serological techniques

•Lower expertise is required than parasitological techniques

•Ability to detect dead larva

•Increased accuracy with molecular identification

•Able to detect other pathogens through multiplex assays (Multiplex PCR)

•Possible to detect from other environments, not only from stool, and urine samples

•Lack of standard for PCR and DNA extraction, causing varied sensitivity, and specificity

•Require increased sampling for higher sensitivity due to irregular larva output or asymptomatic patients