Strongyloides stercoralis: is there a canonical migratory route through the host?

It is generally accepted that the skin-penetrating larvae of Strongyloides stercoralis travel from the skin to the intestinal habitat of the adult stage by an obligatory migratory route that includes the blood, lungs, trachea, and upper gastrointestinal tract in sequence (the pulmonary route). It is assumed, furthermore, that following autoinfective invasion of the bowel wall, S. stercoralis larvae follow this same route to return to the small intestine where they mature. We reexamined the parasite's migratory behavior using a canine isolate of S. stercoralis, specific-pathogen-free pups, radiolabeled larvae, and compressed tissue autoradiography. Compartmental analysis of the number of larvae found in the organ sets examined revealed no reason to reject the simple idea that the pulmonary route was just one of several possible pathways to the duodenum. This was true whether the larvae began their journey in the subcutaneous tissue of the inguinal area or in the distal part of the ileum. Direct sampling of the larvae traversing the trachea indicated that the number of larvae reaching the duodenum by way of the presumptive pulmonary route was insufficient to account for the estimated absolute number actually found there.