Abstract
STRONGYLOIDES STERCORALIS HYPERINFECTION SYNDROME IN COVID-19 PATIENTS TREATED WITH IMMUNOSUPPRESSANTS
Addison Iszler, Algevis Wrench, Ph.D.
Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine (NSU MD)
INTRODUCTION: Strongyloides stercoralis is a helminth capable of completing its entire life cycle within the human body. For this reason, asymptomatic infection with S. stercoralis may persist for years.1 When immunosuppressive agents are given to these patients, a life threatening hyperinfection syndrome and disseminated disease can result.2 Immunosuppressive agents have become a prominent treatment for patients infected with COVID-19.3 This study aims to evaluate the prevalence of S. stercoralis hyperinfection syndrome in COVID-19 patients treated with immunosuppressive agents.
METHODS: A systematic search of PubMed, CINAHL, Cochrane Collection Plus, Embase, and Web of Science was conducted for articles published after 2020. Databases were searched using the terms “covid-19 or coronavirus or 2019-ncov or sars-cov-2 or cov-19” AND “strongyloidiasis” or “Strongyloides”. Articles were assessed by two reviewers and data was extracted from included articles. Three case studies were included in the final analysis. Descriptive statistical analysis was applied to the data obtained.
OUTCOMES: Patients included in this study began showing symptoms of hyperinfection syndrome an average of 15.3 days after the initiation of immunosuppressant therapy. Immunosuppressants administered in these cases included dexamethasone, tocilizumab, and methylprednisolone. Eosinophilia, abdominal discomfort, fever, diarrhea, and itching were among the reported symptoms that emerged following immunosuppressive therapy.
DISCUSSION: Providers should be aware of the risk of hyperinfection syndrome when treating patients from areas that are endemic to S. stercoralis. A preventive treatment with Ivermectin should be considered in patients at risk for strongyloidiasis.4
