COVID-19 and strongyloidiasis: what to expect from this coinfection?

Pereira, Carolina Victoria Marcitelli; Mastandrea, Giovanna Ribeiro Achur; Medeiros, Ana Clara Cassine de Souza; Gryschek, Ronaldo César Borges; Paula, Fabiana Martins de; Corral, Marcelo Andreetta

doi:10.6061/clinics/2021/e3528

Cited by 10 publications

(11 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were 227 strongyloidiasis cases identified, among which four developed SHS and one patient died (Rodríguez-Guardado et al , 2021). However, most of the reported SHS/DS developed during the COVID-19 reconvalescence phase – on average 22.8 days and up to two months after hospital discharge in patients previously treated with corticosteroids (Gautam et al , 2021; Pereira et al , 2021). To accelerate diagnosis, we agree with the authors who emphasize the value of an early upper (and sometimes even lower) gastrointestinal endoscopy and microscopic examination of gastrointestinal and/or respiratory tract samples in diagnosing SHS (Al-Sajee & Al-Hamdani, 2010; Rodriguez et al , 2015; Lier et al , 2020b; Bdioui et al , 2021).…”

Section: Resultsmentioning

confidence: 99%

Strongyloidiasis – diagnostic and therapeutic dilemmas in hyperinfection patients: a case series

et al. 2022

View full text Add to dashboard Cite

The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases ‘Dr. Fran Mihaljević’ in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.

show abstract

Section: Resultsmentioning

confidence: 99%

Strongyloidiasis – diagnostic and therapeutic dilemmas in hyperinfection patients: a case series

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Dexamethasone has been shown to reduce mortality in hospitalized patients with moderate-to-severe COVID-19 [ 85 ]. Although most immunocompetent patients have chronic asymptomatic strongyloidiasis, immunocompromised patients, especially those undergoing corticosteroid therapy, can progress to advanced disease, such as disseminated strongyloidiasis and hyperinfection syndrome [ 86 , 87 ]. The prevalence of COVID-19 and strongyloidiasis coinfection is unclear.…”

Section: Strongyloidiasis and Covid-19mentioning

confidence: 99%

“…The prevalence of COVID-19 and strongyloidiasis coinfection is unclear. Pereira and colleagues summarized the reported cases, in which the majority were male, with an average age of 61.3 years, were discharged from hospital, and then returned with skin presentations and symptoms followed by respiratory and GI symptoms [ 86 , 88 , 89 , 90 , 91 , 92 ]. Symptoms of severe COVID-19 are mainly cough (68.9%), fever (71.6%), dyspnea (71.2%), and diarrhea (20%), while those of Strongyloides hyperinfection syndrome are cough, fever (80.8%), dyspnea or wheeze (88.6%), GI symptoms (71.2%), and disseminated larva currens [ 93 ].…”

Section: Strongyloidiasis and Covid-19mentioning

confidence: 99%

Strongyloides stercoralis: A Neglected but Fatal Parasite

et al. 2022

View full text Add to dashboard Cite

Strongyloidiasis is a disease caused by Strongyloides stercoralis and remains a neglected tropical infection despite significant public health concerns. Challenges in the management of strongyloidiasis arise from wide ranging clinical presentations, lack of practical high sensitivity diagnostic tests, and a fatal outcome in immunocompromised hosts. Migration, globalization, and increased administration of immunomodulators, particularly during the COVID-19 era, have amplified the global impact of strongyloidiasis. Here, we comprehensively review the diagnostic tests, clinical manifestations, and treatment of strongyloidiasis. The review additionally focuses on complicated strongyloidiasis in immunocompromised patients and critical screening strategies. Diagnosis of strongyloidiasis is challenging because of non-specific presentations and low parasite load. In contrast, treatment is simple: administration of single dosage ivermectin or moxidectin, a recent anthelmintic drug. Undiagnosed infections result in hyperinfection syndrome and disseminated disease when patients become immunocompromised. Thus, disease manifestation awareness among clinicians is crucial. Furthermore, active surveillance and advanced diagnostic tests are essential for fundamental management.

show abstract

“…In the first of these papers, the gastric cancer surgery group at the Hospital das Clínicas reported and discussed changes to the number of surgeries and diagnostic procedures during the pandemic (12). The second manuscript discussed the potential risk for patients with COVID-19 to develop strongyloidiasis, a highly neglected parasitic disease (13). Finally, one study based on online survey methods showed that increased levels of screen time and intrafamilial violence during the first wave of the COVID-19 pandemic were associated with poor sleep quality and low health-related quality of life in both healthy and chronically immunosuppressed quarantined adolescents (14).…”

Section: Coronavirus Disease 2019 (Covid-19mentioning

confidence: 99%