and dissemination, most often in patients with im- paired cell mediated immunity. Proper screening in high-risk patients like the ones described in this case- series, and before steroid treatment is mandatory as part of the differential diagnosis in order to guarantee prompt management.
Not all patients with strongyloidiasis had a report of eosinophilia in the peripheral blood, a condition signifi- cant and consistent attributed to this and other intestinal nematodes . In 11 patients complete blood counts with differential counts was either not requested or annotation of results was omitted in the clinical file. We do not have a plausible explanation for this omission, except in two instances of laboratory infrastructure problems. Normal eosinophil level or no eosinophilia in nine patients have to be interpreted with caution, since no follow-up of cases was reported. Lack of per- ipheral eosinophilia in patients with strongyloidiasis carry a poor prognosis for the patient and may con- tribute to decrease suspicion of the infection ; among the eight autopsy cases from Costa Rica, only two presented with 6 % and 22 % eosinophilia, re- spectively .