<i>Strongyloides</i> Hyperinfection Syndrome among COVID-19 Patients Treated with Corticosteroids

Kim, Jani M; Sivasubramanian, Geetha

doi:10.3201/eid2807.220198

Cited by 14 publications

(49 citation statements)

References 11 publications

(9 reference statements)

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“…Lastly, as strongyloidiasis can be positively associated with hosts with underlying disease conditions, concurrent screening for strongyloidiasis and other diseases should be undertaken, especially for immunocompromised patients or patients requiring immunosuppressive drugs. Co-infection of strongyloidiasis with COVID-19 has been reported as well as Strongyloides hyperinfection syndrome resulting from treatment with corticosteroids for COVID-19 [ 54 – 56 ]. With infectious diseases being commonplace, there is an increasing need to screen for Strongyloides to prevent potentially fatal scenarios, especially when the use of corticosteroids is evident [ 57 ].…”

Section: Current Molecular Trends and Novel Tools For Stron...mentioning

confidence: 99%

From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis

Chan

Thaenkham

2023

Parasites Vectors

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Strongyloides stercoralis is a soil-transmitted helminth that is mainly found in the tropical and subtropical regions and affects approximately 600 million people globally. The medical importance of strongyloidiasis lies in its capacity to remain asymptomatic and chronically unnoticed until the host is immunocompromised. Additionally, in severe strongyloidiasis, hyperinfection syndrome and larva dissemination to various organs can occur. Parasitological techniques such as Baermann-Moraes and agar plate culture to detect larvae in stool samples are the current gold standard. However, the sensitivity might be inadequate, especially with reduced worm burden. Complementing parasitological techniques, immunological techniques including immunoblot and immunosorbent assays are employed, with higher sensitivity. However, cross-reactivity to other parasites may occur, hampering the assay’s specificity. Recently, advances in molecular techniques such as polymerase chain reaction and next-generation sequencing technology have provided the opportunity to detect parasite DNA in stool, blood, and environmental samples. Molecular techniques, known for their high sensitivity and specificity, have the potential to circumvent some of the challenges associated with chronicity and intermittent larval output for increased detection. Here, as S. stercoralis was recently included by the World Health Organization as another soil-transmitted helminth targeted for control from 2021 to 2030, we aimed to present a review of the current molecular techniques for detecting and diagnosing S. stercoralis in a bid to consolidate the molecular studies that have been performed. Upcoming molecular trends, especially next-generation sequencing technologies, are also discussed to increase the awareness of its potential for diagnosis and detection. Improved and novel detection methods can aid in making accurate and informed choices, especially in this era where infectious and non-infectious diseases are increasingly commonplace. Graphical Abstract

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Section: Current Molecular Trends and Novel Tools For Stron...mentioning

confidence: 99%

From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis

Chan

Thaenkham

2023

Parasites Vectors

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“…There have been published reports of Strongyloides hyperinfection in patients who received tocilizumab [ 17 , 22 , 24 ], baricitinib [ 15 ], and anakinra [ 24 , 27 ] for the treatment of severe COVID-19. However, as is recommended by major treatment guidelines, all of those patients also received corticosteroids during their course of treatment.…”

Section: Risk Factors For Shs In Covid-19mentioning

confidence: 99%

Strongyloides and COVID-19: Challenges and Opportunities for Future Research

et al. 2023

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Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.

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“…The full-text articles were then assessed for eligibility, which left 17 studies to extract data from. [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] A PRISMA flow diagram was created to show the numbers of publications identified, included and excluded, and the criteria for exclusion (Figure 1). According to the JBI assessment tool for case-report studies, 14 (82.3%) studies were classified as low risk of bias; two studies 38,45 had a moderate risk of bias and one 47 a high risk of bias (Table 1 and Table S1).…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…The characteristics of the individual studies are summarised in Table 1. A total of 15 case reports were from Spain, 36,43,47,48,50 four from the USA, 34,37,45,49 two from India, 40,41 two from Italy, 39,42 and one from Belgium, 46 Iran 35 and Ireland, 38 respectively. Twenty-three of 26 patients (88.4%) lived in developed countries, 34,[36][37][38][39][42][43][44][45][46][47][48][49][50] while 18 of them (69.2%) were immigrants (their nationality/origin was a country distinct from where the case report was published).…”

Section: General Characteristics Of Studiesmentioning

confidence: 99%

“…A total of 15 case reports were from Spain, 36,43,47,48,50 four from the USA, 34,37,45,49 two from India, 40,41 two from Italy, 39,42 and one from Belgium, 46 Iran 35 and Ireland, 38 respectively. Twenty-three of 26 patients (88.4%) lived in developed countries, 34,[36][37][38][39][42][43][44][45][46][47][48][49][50] while 18 of them (69.2%) were immigrants (their nationality/origin was a country distinct from where the case report was published). [36][37][38][39][43][44][45][46][48][49][50] Moreover, the origins of three more patients were different from their residence, albeit their origins were not specified.…”

Section: General Characteristics Of Studiesmentioning

confidence: 99%

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Strongyloides coinfection in COVID‐19 patients treated with corticosteroids: A systematic review

Zulfiqar

Gasser

Ghodsian

et al. 2023

Reviews in Medical Virology

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The COVID‐19 pandemic linked to the virus SARS‐CoV‐2, which began in China, affected ∼765 million people as of 30 April 2023. The widespread use of corticosteroids for the symptomatic treatment of COVID‐19 could lead to the reactivation of infections of opportunistic pathogens, including Strongyloides. We sought to determine the clinical symptoms and demographic characteristics of SARS‐CoV‐2–Strongyloides co‐infection, particularly in patients with severe disease and being treated with immunosuppressive drugs. To do this, we undertook a systematic review of the literature, and searched public accessible scientific databases—the Web of Science, Scopus, PubMed/Medline and Embase –for eligible studies (1 December 2019 to 30 August 2022). The review protocol is registered in PROSPERO (CRD42022377062). Descriptive statistical analyses were used to present the clinical and laboratory parameters of the co‐infection; for this, we calculated prevalence using the following formula: positive cases/total number of cases × 100. Of a total of 593 studies identified, 17 studies reporting 26 co‐infected patients met the criteria for inclusion in this review. The median age of these patients was 55.14 years. Most of cases (53.8%) were treated with dexamethasone, followed by methylprednisolone (26.9%). Eighteen of 26 patients were immigrants living in European countries or the USA; most of these immigrants originated from Latin America (58%) and South‐East Asia (11%). The commonest symptoms of co‐infection were abdominal pain (50%), fever (46.1%), dyspnoea (30.7%) and cough (30.7%), and frequently reported laboratory findings were high absolute eosinophil count (38.4%), high white blood cell count (30.7%), high C‐reactive protein (23.0%) and high neutrophil count (19.2%). Two of the 26 patients (7.7%) had fatal outcomes. Most of the SARS‐CoV‐2–Strongyloides coinfected cases were immigrants living in developed countries, emphasising the need for clinicians in these countries to be aware of clinical and laboratory parameters associated with such co‐infections, as well as the key importance of rapid and accurate diagnostic tests for timely and effective diagnosis and patient management.

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Strongyloides Hyperinfection Syndrome among COVID-19 Patients Treated with Corticosteroids

Cited by 14 publications

References 11 publications

From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis

From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis

Strongyloides and COVID-19: Challenges and Opportunities for Future Research

Strongyloides coinfection in COVID‐19 patients treated with corticosteroids: A systematic review

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