Strongyloides serology - useful for diagnosis and management of strongyloidiasis in rural Indigenous populations, but important gaps in knowledge remain

General practitioners who care for Aboriginal patients in rural and remote communities from tropical Australia must be aware of strongyloidiasis. The prevalence of this parasitic infection is high and occasional cases can have a fatal outcome. Other groups in Australia at high risk of strongyloidiasis are immigrants from endemic countries, particularly from Southeast Asia, and military personnel who have served overseas in endemic areas. Elimination programs for enteric parasites in rural Australian Indigenous communities are so important that a nationally coordinated approach has been advocated. Wisely used, cost-effective diagnostic tests are a critical component of an elimination program. Strongyloidiasis must be confirmed by laboratory diagnosis and the strongyloides ELISA, although not ideal, is a useful test that can be used to diagnose strongyloidiasis and to monitor cure. In this article the value of the current strongyloides ELISA is discussed and a cost-benefit analysis is conducted using direct costs only. In a typical rural Aboriginal community in tropical Australia with prevalence of strongyloidiasis at 20% each true positive case detected by the strongyloides ELISA is estimated to cost approximately AU590 dollars to diagnose and manage until cure, proven by negative serology.