Strongyloides Hyperinfection Syndrome Following Corticosteroid Therapy in a Patient with COVID-19 infection: A Case Report

Babazadeh, Sara; Shokri‐Shirvani, Javad; Ranaee, Mohammad

doi:10.30699/ijmm.16.3.267

Cited by 6 publications

(34 citation statements)

References 13 publications

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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%

“…34 The mean age of cases was calculated to be 53.8 � 16.02; 14 (53.8%) of the 26 patients were male, [34][35][36][37][39][40][41]43,45,46,[48][49][50] and nine were female (34.6%) 36,38,42,44,48 ; the sex of 3 patients was not known 47 ; 12 (46.1%) patients had co-morbidities. [34][35][36][37]39,[41][42][43]46,[48][49][50] Eight (28.5%) patients developed SHS. 35,37,38,40,41,43,45,49 Seven (26.9%) patients had diabetes, 37,39,41,42,46,48,49 five (19.2%) had hypertension, 34,36,49,…”

Section: Demography and Comorbiditiesmentioning

confidence: 99%

“…[34][35][36][37]39,[41][42][43]46,[48][49][50] Eight (28.5%) patients developed SHS. 35,37,38,40,41,43,45,49 Seven (26.9%) patients had diabetes, 37,39,41,42,46,48,49 five (19.2%) had hypertension, 34,36,49,50 four (15.3%) had immunosuppressive conditions, 39,42,43,48 two (7.7%) had cardiovascular conditions 34,35 and one (3.8%) had Crohn's disease (Table 2). 48 For 10 of all 17 eligible studies, patients were also tested for infections with other viruses, bacteria and/or parasites; four studies demonstrated bacterial coinfections, 34,37,41,49…”

Section: Demography and Comorbiditiesmentioning

confidence: 99%

“…41 The following methods were commonly used for the diagnosis of S. stercoralis infection: serological testing using enzymelinked immunosorbent assay (n = 9, 34.6% of patients), 34,[40][41][42][44][45][46]50 and sputum examination using cultures (n = 5, 19.2%). 37,41,43,45,49 Other methods employed included histopathology, 35 modified Baermann funnel method, and formalin-ether concentration technique, 39 immunofluorescence antibody test (one case each). 42…”

Section: Treatment and Diagnosismentioning

confidence: 99%

“…37,[39][40][41][42]45,[48][49][50] Other clinical manifestations were dyspnoea (n = 9, 34.6%), 39,41,43,45,[48][49][50] cough (n = 8, 30.7%), 37,[48][49][50] diarrhoea (n = 6, 23.0%) 34,40,41,45,48 and pruritus (n = 4, 15.3%). 36,41,42,44 Patients also presented with nausea (n = 3, 11.5%), 34,35,49 vomiting (n = 3, 11.5%), 34,39,43 anorexia (n = 2, 7.6%), 34,35 chest pain (n = 2, 7.6%), 35,50 weight loss (n = 1, 3.8%) 34 and haemoptysis (n = 1, 3.8%). 40,41 Commonly reported clinical laboratory findings for blood samples were high absolute eosinophil count (n = 10, 38.4%), 34,35,37,39,42,[44]…”

Section: Clinical and Laboratory Characteristicsmentioning

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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Section: Overview Of Studiesmentioning

confidence: 99%

Section: Demography and Comorbiditiesmentioning

confidence: 99%

Section: Demography and Comorbiditiesmentioning

confidence: 99%

Section: Treatment and Diagnosismentioning

confidence: 99%

Section: Clinical and Laboratory Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

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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Insights into parasites and COVID-19 co-infections in Iran: a systematic review

Molaei,

Asfaram,

Mashhadi

et al. 2024

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background It is well-documented that using immunosuppressive drugs such as corticosteroids or cytokine blockers in treating coronavirus disease 2019 (COVID-19) increases the risk of co-infections. Here we systematically summarized the cases of COVID-19-associated parasitic infections (CAPIs) in Iran. Methods From 19 February 2020 to 10 May 2023, all studies on Iranian patients suffering from CAPIs were collected from several databases using a systematic search strategy. Results Of 540 records, 11 studies remained for data extraction. In this research, most of the studies were related to Lophomonas and Toxoplasma. Of 411 cases of CAPIs, toxoplasmosis (385 [93.7%]) had the highest rate of infection among Iranian patients, followed by blastocystosis (15 [3.6%]), fascioliasis (4 [0.97%]), leishmaniasis (3 [0.7%]), lophomoniasis (3 [0.7%]) and strongyloidiasis (1 [0.2%]). In general, Blastocystis enhanced diarrhoea in patients with COVID-19. Lophomonas, Toxoplasma and Strongyloides increased the severity of COVID-19, but Fasciola decreased its intensity. Patients with a history of cutaneous leishmaniasis showed mild symptoms of COVID-19. Also, patients with a prior history of hydatid cysts were not affected by COVID-19. Conclusions Due to the similar symptoms of some parasitic diseases and COVID-19 and immunosuppressive treatment regimens in these patients that may cause the reactivation or recurrence of parasitic infections, early diagnosis and treatment are required.

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Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas

et al. 2023

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Background Fatal forms of strongyloidiasis, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), are caused by exaggerated autoinfection of the intestinal nematode, Strongyloides stercoralis (S. stercoralis). Corticosteroids, frequently administered to patients with severe COVID-19, can transform chronic asymptomatic strongyloidiasis into the above-mentioned fatal diseases. This study aimed to investigate the prevalence of strongyloidiasis in COVID-19 patients receiving corticosteroids in a hypoendemic region. Methods The present cross-sectional study enrolled 308 COVID-19 patients admitted to two hospitals in Ahvaz and Abadan in the southwest of Iran between 2020 and 2022. A real-time reverse transcription polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) scan were employed to detect and monitor the disease’s severity in the patients, respectively. All patients were evaluated for IgG/IgM against S. stercoralis using Enzyme-linked immunosorbent assay (ELISA) test. Subsequently, individuals with a positive ELISA test were confirmed using parasitological methods, including direct smear and agar plate culture (APC). Results The patients were between 15 and 94 years old, with a mean age of 57.99 ± 17.4 years. Of the 308 patients, 12 (3.9%) had a positive ELISA test, while 296 (96.1%) had negative results. Three of the 12 patients with a positive ELISA result died, and three failed to provide a stool sample. To this end, only six cases were examined parasitologically, in which S. stercoralis larvae were observed in five patients. Significant differences were found between S. stercoralis infection with sex (p = 0.037) and age (p = 0.027). Binary regression analysis revealed that strongyloidiasis was positively associated with sex (odds ratio [OR]: 5.137; 95% confidence interval [CI]: 1.107–23.847), age (OR: 5.647; 95% CI 1.216–26.218), and location (OR: 3.254; 95% CI: 0.864–12.257). Conclusions Our findings suggest that screening for latent strongyloidiasis in COVID-19 patients in endemic areas using high-sensitivity diagnostic methods, particularly ELISA, before receiving suppressive drugs should be given more consideration.

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Strongyloides Hyperinfection Syndrome Following Corticosteroid Therapy in a Patient with COVID-19 infection: A Case Report

Cited by 6 publications

References 13 publications

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

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

Insights into parasites and COVID-19 co-infections in Iran: a systematic review

Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas

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