Activating Dormant Strongyloidiasis Secondary to COVID-19 Treatment

Abstract

The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids as a treatment option. However, multiple studies showed an association between of opportunistic and bacterial infections in patients under corticosteroid therapy. We report a case of a 76-year old patient diagnosed with COVID-19 pneumonia, treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited Strongyloides stercoralis endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and should be also implemented empirical in high risk groups, where obtaining a diagnosis is unfeasible.

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

“…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).…”

“…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).…”

“…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.…”

“…The regions included Africa (AFR), the Americas (AMR), South-East Asia (SEAR), Europe (EUR), Eastern Mediterranean (EMR) and Western Pacific (WPR). Most patients came from AMR (58%), 34,36,[43][44][45][46][48][49][50] followed by SEAR (11%). 37,39-41…”

“…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,…”