I suspected that bacterial meningitis developed in the patient from an enteric organism as a complication of the stron-gyloides hyperinfection syndrome and discussed the tests that I would have used to make the diagnosis in this case. I appreciate the correspondence from Gaffin, because it affords the opportunity to emphasize again the need for clinicians to test for chronic strongyloidiasis before administering immunosuppressive medications to patients who are at risk for this infection. My practice has also been to use serologic testing for strongyloides by means of ELISA to diagnose chronic strongyloidiasis in these patients, for the reasons noted by Gaffin.
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