Preventing Infectious Complications of Immunomodulation in COVID-19 in Foreign-Born Patients

Mohareb, Amir M.; Rosenberg, Jacob M.; Bhattacharyya, Roby P.; Kotton, Camille Nelson; Chu, Jacqueline T.; Jilg, Nikolaus; Hysell, Kristen; Albin, John S.; Sen, Pritha; Bloom, Seth M.; Schiff, Abigail E.; Zachary, Kimon C.; Letourneau, Alyssa R.; Kim, Arthur Y.; Hurtado, Rocio

doi:10.1007/s10903-021-01225-4

Cited by 4 publications

(8 citation statements)

References 10 publications

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“…Different algorithms [10][11][12][13][14] have been proposed to guide the risk assessment and management of SHS among patients with relevant epidemiological exposure, suffering from SARS-CoV-2 infection and requiring corticosteroids. Earlier algorithms assessed the risk and management of SHS in the case of immunosuppression in general [7,11] and can actually be adapted for the prescription of dexamethasone or other biological therapy in SARS-CoV-2-related complications.…”

Section: Screening Algorithm For Strongyloidiasismentioning

confidence: 99%

A Practical Approach to Screening for Strongyloides stercoralis

et al. 2021

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Strongyloides stercoralis, causative agent of a neglected tropical disease, is a soil-transmitted helminth which may cause lifelong persisting infection due to continuous autoinfection. In the case of immunosuppression, life-threatening hyperinfection and disseminated strongyloidiasis can develop. We propose a pragmatic screening algorithm for latent strongyloidiasis based on epidemiologic exposure and immunosuppression status that can be applied for any kind of immunosuppressive therapy. The algorithm allows the diagnosis of latent strongyloidiasis with optimal accuracy in a well-equipped setting, while for endemic settings where the complete testing array is unavailable, an empiric treatment is generally recommended. Accurate diagnosis and extensive empiric treatment will both contribute to decreasing the current neglect of strongyloidiasis.

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Section: Screening Algorithm For Strongyloidiasismentioning

confidence: 99%

A Practical Approach to Screening for Strongyloides stercoralis

et al. 2021

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“…Importantly, the algorithm by De Wilton et al also highlights the symptoms and signs of Strongyloides hyperinfection, such as rash, diarrhea, and respiratory deterioration with immunosuppression, which may help identify those who may have been considered to be low risk at the time of admission. Mohareb and colleagues proposed a more comprehensive screening algorithm to prevent the infectious complications of immunomodulation in foreign-born patients with COVID-19, including latent TB, hepatitis B, Chagas disease, endemic mycoses, herpesviruses, and opportunistic fungal pathogens, as well as the presumptive treatment with ivermectin for Strongyloides, unless a rapid turnaround time serologic assay is available [ 90 ]. However, the approaches mentioned above are rather specific to the context in which they were created, and are not achievable in settings that are highly endemic for Strongyloides.…”

Section: Screeningmentioning

confidence: 99%

“…It should be noted that in both HIC and LMIC settings, the decision regarding the initiation of corticosteroids for patients with severe COVID-19, thus requiring respiratory support, is a key management priority. The slow turnaround times for Strongyloides diagnostic testing, such as serologic assays at a reference laboratory, represent a significant barrier to the implementation of the proposed screening algorithms [ 85 , 90 ]. Furthermore, hospitalized patients with COVID-19 are often critically ill, which may preclude the ability to gather a full epidemiologic risk profile.…”

Section: Screeningmentioning

confidence: 99%

“…Given the limitations of the screening algorithms discussed above, some authors have suggested the presumptive treatment of chronic strongyloidiasis with ivermectin prior to the initiation of corticosteroids as a reasonable approach to prevent Strongyloides hyperinfection. This is especially pragmatic in low endemicity settings where there may be significant delays in obtaining the laboratory results for high-risk, foreign-born populations [ 3 , 85 , 87 , 90 ]. However, this approach could also foster shortages of ivermectin, similar to the shortages observed during the periods of high utilization of off-label ivermectin as an unproven COVID-19 treatment [ 85 ].…”

Section: Treatment Of Strongyloides In Covid-19mentioning

confidence: 99%

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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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“…1,2 Apart from corticosteroids other immunomodulators such as tocilizumab which are also commonly used in severe COVID-19 patients are also suspected to cause reactivation of a number of infections including tuberculosis. 3 Not only administration of immunomodulators but chronic conditions like diabetes is a risk factor for tuberculosis reactivation which shouldn't be overlooked. 4 Animal studies suggested that COVID-19 is itself a risk factor and responsible for the reactivation of dormant tuberculosis that further needs to be clinically correlated specially in the era when every third person is said to have tuberculosis infection in the world as per WHO.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 and tuberculosis reactivation: a systematic review assessing most common risk factors

Tewari

Yadav²

2022

Int J Basic Clin Pharmacol

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COVID-19 as a pandemic not only shifted the focus of the healthcare system from other diseases but also affected the disease progression of infections like tuberculosis which remained a leading killer in the past worldwide. COVID-19 itself is said to reactivate latent tuberculosis as shown in animal experiments. Immunomodulators such as corticosteroids and tocilizumab which are being used for covid treatment even further predisposes patients to tuberculosis reactivation and increased progression of the disease. Diabetes is already known to be a risk factor for tuberculosis reactivation and impact tuberculosis progression and worsen the situation. The exact mechanism of interaction of covid-19 and tuberculosis and their effect on each other remains unknown. Considering high prevalence of tuberculosis and the current scenario of covid-19 in world, there is need to study the impact of covid-19 infection on tuberculosis progression or reactivation and commonly associated risk factors. We conducted a systematic search of the online databases to collect data of patients who had tuberculosis reactivation or increased progression of disease after covid-19 infection. Data of a total of 18 patients was retrieved and used for the syntheses of the study. Diabetes was present in 50% of the patients. 55.5% patients were administered corticosteroids for covid-19 treatment later presenting with tuberculosis. Tocilizumab however was administered to 22.2% patients who also received corticosteroids. 27.7% patients suffered tuberculosis reactivation after covid-19 infection without history of diabetes and corticosteroid or tocilizumab administration. None of the patients were reported to have HIV infection. Major risk factors present in patients included corticosteroid administration and diabetes. However, tuberculosis reactivation was seen even in absence of these factors indicating that covid-19 infection may itself be responsible for tuberculosis reactivation. The exact mechanism however remains unknown and further clinical studies are needed to know the same.

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Preventing Infectious Complications of Immunomodulation in COVID-19 in Foreign-Born Patients

Cited by 4 publications

References 10 publications

A Practical Approach to Screening for Strongyloides stercoralis

A Practical Approach to Screening for Strongyloides stercoralis

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

COVID-19 and tuberculosis reactivation: a systematic review assessing most common risk factors

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