Risk of Strongyloides Hyperinfection Syndrome when prescribing dexamethasone in severe COVID-19

Wilton, Angus de; Nabarro, Laura; Godbole, Gauri; Chiodini, Peter L.; Boyd, Aileen; Woods, Katherine

doi:10.1016/j.tmaid.2021.101981

Cited by 30 publications

(26 citation statements)

References 6 publications

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“…Since high-dose steroid or tocilizumab treatment is recommended for severe SARS-CoV-2 presentation, SHS and disseminated strongyloidiasis have been described in patients with undetected latent strongyloidiasis [8,9]; moreover, it is possible that cases of Gram-negative bacteremia driven by Strongyloides hyperinfection have been overlooked by clinicians due to a lack of awareness. An increased incidence of SHS can be expected in high-endemic countries as well as more sporadic cases in low-endemic countries, where the admission to critical care for SARS-CoV-2 related ARDS is most common in south Asian, African and other ethnic minority groups [10] probably due to lower vaccination coverage, over-crowded housing conditions and untreated cardiovascular and metabolic comorbidities.…”

Section: Strongyloidiasis and Sars-cov-2 Infection: The Reason For Th...mentioning

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: Strongyloidiasis and Sars-cov-2 Infection: The Reason For Th...mentioning

confidence: 99%

A Practical Approach to Screening for Strongyloides stercoralis

et al. 2021

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“…S. stercoralis is estimated to infect at least 610 million people worldwide 12 ; infections can be fatal for immunosuppressed individuals [13][14][15] . Current therapeutics against parasitic nematodes exclusively target ongoing infections.…”

Section: Soil-transmitted Gastrointestinal Helminths Such As the Human Threadwormmentioning

confidence: 99%

The neural basis of temperature-driven host seeking in the human threadworm Strongyloides stercoralis

Bryant

Ruiz

Lee

et al. 2021

Preprint

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Soil-transmitted parasitic nematodes infect approximately one billion people and are a major cause of morbidity worldwide. The infective larvae (iL3s) of these parasites actively search for hosts in a poorly understood, sensory-driven process that requires thermal cues. Here, we describe the neural basis of temperature-driven host seeking in parasitic nematodes using the human threadworm Strongyloides stercoralis. We show that S. stercoralis thermosensation is mediated by the AFD neurons, a thermosensory neuron class that is conserved between parasitic and free-living nematodes. We demonstrate that S. stercoralis AFD displays parasite-specific adaptations that enable both nonlinear and linear encoding of temperatures up to human body temperature. Furthermore, we describe a novel thermosensory behavior in which S. stercoralis iL3s generate spontaneous reversals of temperature preference at below-body temperatures. Finally, we identify three thermoreceptors selectively expressed in S. stercoralis AFD that display parasite-specific sensitivities to human body temperatures and likely enable temperature-driven host seeking by iL3s. Our results are the first direct evidence that the sensory neurons of soil-transmitted parasitic nematodes exhibit parasite-specific neural adaptations and sensory coding strategies that allow them to target human hosts, a finding with important implications for efforts to develop new therapeutic strategies for nematode control.

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“…The advancing knowledge of the physiopathology suggests that a rapid replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may lead to an exacerbated immune response involving many cytokines (cytokine storm), triggering a severe inflammatory response in the lungs. Using corticosteroids and anticoagulants in such cases has produced beneficial results (3)(4)(5), with dexamethasone and methylprednisolone being used most frequently (6)(7).…”

mentioning

confidence: 99%

“…Once the helminth parasite is detected, anti-helminthic treatment is recommended before corticosteroid therapy is administered. De Wilton et al (5) proposed an algorithm for screening the risk of S. stercoralis exposure in patients samples with COVID-19 at a hospital in England. In general, all patients who had travelled or immigrated from endemic areas and those with a high risk of S. stercoralis infection underwent a diagnostic test and treatment with ivermectin.…”

mentioning

confidence: 99%