Influence of the drugs used in migrant patients with severe acute respiratory syndrome coronavirus 2 and the development of symptomatic strongyloidiasis

Lorenzo, Helena Carvalho De; Carbonell, Cristina; Santiago, María Belén Vicente; López-Bernús, Amparo; Ulerio, Josué Pendones; Bellido, Juan Luis Muñoz; Muro, Antonio; Belhassen‐García, Moncef

doi:10.1093/trstmh/trab152

Cited by 7 publications

(44 citation statements)

References 15 publications

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“…Table 1 describes the main characteristics of two observational studies from the scoping review. 12,13 Overall, these two studies were observational studies without comparative groups to evaluate the characteristics of strongyloidiasis in COVID-19, specifically the effect of drugs used in COVID-19 on the evolution of strongyloidiasis and the current situation regarding diagnostic and treatment protocols for strongyloidiasis in COVID-19 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Lorenzo et al 12 conducted a longitudinal study by reviewing patients diagnosed with COVID-19 from a tertiary care hospital in central-western Spain. Although their sample size was small (N 5 86), they identified seven patients with strongyloidiasis; of the seven, three received dexamethasone, and none received tocilizumab.…”

Section: Resultsmentioning

confidence: 99%

“…However, the prevalence of strongyloidiasis during the COVID-19 pandemic could be higher than generally considered due to a potential underdiagnosis. 12,13 Notably, the two observational studies were performed in Spain, where the overall seroprevalence of S. stercoralis was reportedly around 9%. 22 Although there are several case reports from the country, most patients in the reports were migrants from endemic regions such as from Honduras or Bolivia, where the estimated prevalence of S. stercoralis is close to or more than 10%.…”

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics of Strongyloidiasis during the COVID-19 Pandemic: Systematic Scoping Review

Tanariyakul

Chang

Keitoku

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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The clinical impact of Strongyloides stercoralis hyperinfection secondary to immunosuppressive therapy for coronavirus disease 2019 (COVID-19) has been an emerging topic of interest, although characteristics of Strongyloides infection in COVID-19 patients are not yet well characterized. This study summarizes the existing evidence of Strongyloides infection in COVID-19 patients and recommends future areas of research. According to the PRISMA Extension for Scoping Reviews, we performed a search on MEDLINE and EMBASE for articles with keywords including “Strongyloides,” “Strongyloidiasis,” and “COVID-19” from the inception of these databases to June 5, 2022. A total of 104 articles were found. After excluding duplication and thorough reviews, 11 articles, including two observational studies, one conference abstract, and nine case reports or series, were included. Two observational studies focused on revealing the prevalence of Strongyloides screening in COVID-19 patients and clinical follow-up. Among the included cases, patients were mostly from low- or middle-income countries and suffered from severe or critical COVID-19. Strongyloides hyperinfection and disseminated infection were reported in 60% and 20%, respectively. Interestingly, 40% did not have eosinophilia, a hallmark of parasitic infection, potentially leading to delay in diagnosis of strongyloidiasis. This systematic review summarizes the clinical characteristics of strongyloidiasis in COVID-19 infection. Although further studies to identify risks and precipitants associated with the onset of strongyloidiasis are crucial, increased awareness of the critical condition is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical Characteristics of Strongyloidiasis during the COVID-19 Pandemic: Systematic Scoping Review

Tanariyakul

Chang

Keitoku

et al. 2023

The American Journal of Tropical Medicine and Hygiene

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“…Unfortunately, although 885 of the total patient population born outside the U.S. were noted to have eosinophilia, only 356 patients (40.2%) underwent serologic testing for Strongyloides, highlighting the lack of healthcare provider awareness of this condition in low endemicity settings. A similar study conducted in Spain on 2567 patients with COVID-19 identified 86 patients from geographic areas considered endemic for Strongyloides, and identified 7 patients (8%) with Strongyloides infection based on serology (1 from Africa and 6 from Latin America) [ 29 ]. All of these patients survived with good outcomes and none required ICU care.…”

Section: Screeningmentioning

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%

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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Influence of the drugs used in migrant patients with severe acute respiratory syndrome coronavirus 2 and the development of symptomatic strongyloidiasis

Cited by 7 publications

References 15 publications

Clinical Characteristics of Strongyloidiasis during the COVID-19 Pandemic: Systematic Scoping Review

Clinical Characteristics of Strongyloidiasis during the COVID-19 Pandemic: Systematic Scoping Review

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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