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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
  1. Buonfrate  D, Bisanzio  D, Giorli  G, Odermatt  P, Fürst  T, Greenaway  C, et al. The global prevalence of Strongyloides stercoralis infection. Pathogens. 2020;9:468. DOIPubMedGoogle Scholar
  2. Nutman  TB. Human infection with Strongyloides stercoralis and other related Strongyloides species. Parasitology. 2017;144:263–73. DOIPubMedGoogle Scholar
  3. Pereira  CVM, Mastandrea  GRA, Medeiros  ACCS, Gryschek  RCB, Paula  FM, Corral  MA. COVID-19 and strongyloidiasis: what to expect from this coinfection? Clinics (São Paulo). 2021;76:e3528. DOIPubMedGoogle Scholar
  4. Stylemans  D, Van Cauwelaert  S, D’Haenens  A, Slabbynck  H. COVID-19–associated eosinopenia in a patient with chronic eosinophilia due to chronic strongyloidiasis. Infect Dis Clin Pract (Baltim Md). 2021;29:e305–6. DOIPubMedGoogle Scholar
  5. Lier  AJ, Tuan  JJ, Davis  MW, Paulson  N, McManus  D, Campbell  S, et al. Case report: disseminated strongyloidiasis in a patient with COVID-19. Am J Trop Med Hyg. 2020;103:1590–2. DOIPubMedGoogle Scholar
  6. Marchese  V, Crosato  V, Gulletta  M, Castelnuovo  F, Cristini  G, Matteelli  A, et al. Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia. Infection. 2021;49:539–42. DOIPubMedGoogle Scholar
  7. Gautam  D, Gupta  A, Meher  A, Siddiqui  F, Singhai  A. Corticosteroids in Covid-19 pandemic have the potential to unearth hidden burden of strongyloidiasis. IDCases. 2021;25:e01192. DOIPubMedGoogle Scholar
  8. Norman  FF, Chamorro  S, Braojos  F, López-Miranda  E, Chamorro  J, González  I, et al. Strongyloides in bronchoalveolar lavage fluid: practical implications in the COVID-19 era. J Travel Med. 2022;29: taab114 .
  9. Feria  L, Torrado  M, Anton-Vazquez  V. Reactivation of Strongyloides stercoralis in patients with SARS-CoV-2 pneumonia receiving dexamethasone. Med Clin (Barc). 2022;158:242–3. DOIGoogle Scholar
  10. Stauffer  WM, Alpern  JD, Walker  PF. COVID-19 and dexamethasone: a potential strategy to avoid steroid-related Strongyloides hyperinfection. JAMA. 2020;324:623–4. DOIPubMedGoogle Scholar

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