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Volume 28, Number 7—July 2022
Research Letter

Strongyloides Hyperinfection Syndrome among COVID-19 Patients Treated with Corticosteroids

Jani M. Kim and Geetha SivasubramanianComments to Author 
Author affiliation: University of California San Francisco, Fresno, California, USA

Main Article

Table

Characteristics of previously reported Strongyloides infections in patients with SARS-CoV-2 pneumonia*

Ref no. Patient age, y/sex Reporting country Country of origin COVID-19 treatment Strongyloides
Eosinophil pattern
Diagnosis Treatment
(3)
59/M
Belgium
Ecuador
Anakinra, methylprednisolone 80 mg tapered over 1 month
Positive serologic test; RT-PCR positive for S. stercoralis in fecal samples
Single dose ivermectin
Initial eosinopenia (0 cells/mL), elevated to 2,670 cells/mL after steroid exposure, decreased after ivermectin
(4)
68/M
United States
Ecuador
Tocilizumab ×1 d and methylprednisolone ×8 d
Sputum culture positive for larvae; positive Strongyloides IgG serology
Ivermectin and albendazole ×2 wk
Initial eosinopenia (0 cells/mL), elevated to 1,900 cells/mL after steroid exposure, decreased to 900 cells/mL after ivermectin
(5)
59/M
Italy
Southern Italy
Hydroxychloroquine, lopinavir/ritonavir, tocilizumab ×2 d, dexamethasone ×11 d
Stool microscopy positive for rhabditiform larvae; serology positive at 1:640
Oral ivermectin ×4 d
Elevated to 5,540 cells/μL after steroid exposure, rapid decrease after ivermectin
(6)
53/M
India
Central India
Methylprednisolone 60 mg intravenous 2×/d ×5 d
Stool microscopy positive for rhabditiform larvae of S. stercoralis
Ivermectin and albendazole ×2 wk
Unremarkable
(7)
69/M
Spain
Colombia
Methylprednisolone
Bronchoalveolar fluid positive for larvae
Oral ivermectin ×2 wk
Unremarkable
(8) 44/M Spain Bolivia Dexamethasone Positive ELISA IgG serology, 2.27† Oral ivermectin ×2 d Eosinopenia before treatment, no further report
74/F Spain Honduras Dexamethasone Positive ELISA IgG serology, 2.47† Oral ivermectin ×2 d Eosinopenia before treatment, no further report

*All patients recovered. Ref, reference; RT-PCR, reverse transcription PCR. †Normal value <1.01.

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References
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Page created: June 09, 2022
Page updated: June 18, 2022
Page reviewed: June 18, 2022
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