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Alam AM, Ozdemir C, Reza N. Strongyloides stercoralis infection in the United Kingdom: a systematic review and meta-analysis of published cases. Clin Med (Lond) 2024:100227. [PMID: 39009349 DOI: 10.1016/j.clinme.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/10/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Strongyloidiasis is a helminth infection where symptoms vary, and asymptomatic presentation is common. Chronic strongyloidiasis can cause a high mortality 'hyper-infection' in immunocompromised states. Understanding at risk populations and symptomology can guide screening and early treatment to reduce hyper-infection risk. A systematic review of studies describing patients in the United Kingdom with strongyloidiasis a pooled total of 1308 patients. Weighted pooled prevalence (WPP) of asymptomatic cases was 27.7% (95%CI 17.1-39.5%,I2 = 92%,p<0.01]. At risk populations included migrants, returning travellers and armed forced personnel. The most common symptoms reported were abdominal pain (WPP 32.1%,[95%CI 20.5-44.8%],I2 = 93%,p<0.01), rashes (WPP 38.4%,[95%CI 13.1-67.7%],I2 = 99%, p<0.01) and diarrhoea (WPP 12.6% [95%CI 6.7-19.9%],I2=70%,p=0.03). Symptomatology varied with cohort characteristics. Although asymptomatic presentation is common, patients may present with abdominal pain, diarrhoea, or rashes. A low threshold for screening symptomatic individuals in at-risk groups is required.
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Affiliation(s)
- Ali M Alam
- Internal Medicine Trainee, Newham Hospital, Barts Health NHS Trust, London, UK
| | - Cansu Ozdemir
- Medical Student, GKT School of Medical Education, King's College London, London, UK
| | - Nada Reza
- NIHR Academic Clinical Fellow in Infectious Diseases, Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, 6 West Derby Street, University of Liverpool, Liverpool L7 8TX, UK.
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2
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Pérez-Jacoiste Asín MA, De Castro M, De Dios B, Pérez-Ayala A, Lalueza A, García-Reyne A, Losada I, Herrero-Martínez JM, Jiménez PH, Lumbreras C, Lizasoain M, López Medrano F. Enhancing screening adherence for strongyloides infection in latinx inpatients with COVID-19: a local protocol implementation study. Pathog Glob Health 2024; 118:232-240. [PMID: 37525476 PMCID: PMC11221480 DOI: 10.1080/20477724.2023.2240088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome has been observed in immunosuppressed coronavirus disease 2019 (COVID-19) patients. Detecting and treating asymptomatic Strongyloides infection in individuals from endemic areas can effectively prevent hyperinfection. Unfortunately, many clinicians are unaware of this neglected infection. Therefore, we aimed to evaluate whether including Strongyloides screening in COVID-19 management protocols would encourage this practice. To accomplish this, we conducted a retrospective single-center study at 'Hospital Universitario 12 de Octubre' in Madrid, Spain, comparing two consecutive cohorts. The first cohort comprised all Latinx patients over 18 years old who were admitted for COVID-19 between March 1st and April 30th, 2020. The second cohort consisted of Latinx patients admitted between July 1st and December 31st, 2020, following an amendment to the COVID-19 management protocol that recommended screening for strongyloidiasis in at-risk patients. We identified 559 and 795 patients in the first and second periods, respectively. The percentage of individuals screened increased significantly from 8.8% to 51.6% after the screening recommendation was included in the protocol (odds ratio [OR] 11.08, 95% confidence interval [CI] 8.01-15.33). In both periods, the screening rate was significantly higher among those receiving immunosuppression than those who did not receive steroids and/or tocilizumab. No other factors influenced the screening rate. In conclusion, including strongyloidiasis screening recommendations in COVID-19 management protocols led to its increased implementation. However, the overall screening rate remained low, emphasizing the need for further efforts to enhance screening practices.
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Affiliation(s)
- María Asunción Pérez-Jacoiste Asín
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta De Castro
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Begoña De Dios
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Pérez-Ayala
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana García-Reyne
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Losada
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Juan María Herrero-Martínez
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | | | - Carlos Lumbreras
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Manuel Lizasoain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco López Medrano
- School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
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3
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Chastain DB, Spradlin M, Ahmad H, Henao-Martínez AF. Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults. Clin Infect Dis 2024; 78:e37-e56. [PMID: 37669916 DOI: 10.1093/cid/ciad474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/07/2023] Open
Abstract
Glucocorticoids are widespread anti-inflammatory medications used in medical practice. The immunosuppressive effects of systemic glucocorticoids and increased susceptibility to infections are widely appreciated. However, the dose-dependent model frequently used may not accurately predict the risk of infection in all patients treated with long-term glucocorticoids. In this review, we examine the risks of opportunistic infections (OIs) in patients requiring glucocorticoid therapy by evaluating the influence of the glucocorticoid dose, duration, and potency, combined with biological and host clinical factors and concomitant immunosuppressive therapy. We propose strategies to prevent OIs, which involve screening, antimicrobial prophylaxis, and immunizations. While this review focuses on patients with autoimmune, inflammatory, or neoplastic diseases, the potential risks and preventative strategies are likely applicable to other populations. Clinicians should actively assess the benefit-harm ratios of systemic glucocorticoids and implement preventive efforts to decrease their associated infections complications.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Megan Spradlin
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hiba Ahmad
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Andrews HS, Herman JD, Gandhi RT. Treatments for COVID-19. Annu Rev Med 2024; 75:145-157. [PMID: 37722709 DOI: 10.1146/annurev-med-052422-020316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
The treatment for COVID-19 has evolved rapidly since the start of the pandemic and now consists mainly of antiviral and immunomodulatory agents. Antivirals, such as remdesivir and nirmatrelvir-ritonavir, have proved to be most useful earlier in illness (e.g., as outpatient therapy) and for less severe disease. Immunomodulatory therapies, such as dexamethasone and interleukin-6 or Janus kinase inhibitors, are most useful in severe disease or critical illness. The role of anti-SARS-CoV-2 monoclonal antibodies has diminished because of the emergence of viral variants that are not anticipated to be susceptible to these treatments, and there still is not a consensus on the use of convalescent plasma. COVID-19 has been associated with increased rates of venous thromboembolism, but the role of antithrombotic therapy is limited. Multiple investigational agents continue to be studied, which will alter current treatment paradigms as new data are released.
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Affiliation(s)
- Hayden S Andrews
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; ,
| | - Jonathan D Herman
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Ragon Institute of Mass General, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Rajesh T Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; ,
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5
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Bayo Sánchez C, Razquin Olazarán I, Martín Salas C, Portillo Bordonabe ME, Ezpeleta Baquedano C. Answer to the Photo Quiz: Unexpected finding in a Gram stain. J Clin Microbiol 2023; 61:e0064223. [PMID: 37987731 PMCID: PMC10662333 DOI: 10.1128/jcm.00642-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Affiliation(s)
- Cristina Bayo Sánchez
- Servicio de Microbiología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Iosu Razquin Olazarán
- Servicio de Microbiología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Carmen Martín Salas
- Servicio de Microbiología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Zulfiqar S, Gasser RB, Ghodsian S, Almukhtar M, Holland C, Rostami A. Strongyloides coinfection in COVID-19 patients treated with corticosteroids: A systematic review. Rev Med Virol 2023; 33:e2469. [PMID: 37353858 DOI: 10.1002/rmv.2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
The COVID-19 pandemic linked to the virus SARS-CoV-2, which began in China, affected ∼765 million people as of 30 April 2023. The widespread use of corticosteroids for the symptomatic treatment of COVID-19 could lead to the reactivation of infections of opportunistic pathogens, including Strongyloides. We sought to determine the clinical symptoms and demographic characteristics of SARS-CoV-2-Strongyloides co-infection, particularly in patients with severe disease and being treated with immunosuppressive drugs. To do this, we undertook a systematic review of the literature, and searched public accessible scientific databases-the Web of Science, Scopus, PubMed/Medline and Embase -for eligible studies (1 December 2019 to 30 August 2022). The review protocol is registered in PROSPERO (CRD42022377062). Descriptive statistical analyses were used to present the clinical and laboratory parameters of the co-infection; for this, we calculated prevalence using the following formula: positive cases/total number of cases × 100. Of a total of 593 studies identified, 17 studies reporting 26 co-infected patients met the criteria for inclusion in this review. The median age of these patients was 55.14 years. Most of cases (53.8%) were treated with dexamethasone, followed by methylprednisolone (26.9%). Eighteen of 26 patients were immigrants living in European countries or the USA; most of these immigrants originated from Latin America (58%) and South-East Asia (11%). The commonest symptoms of co-infection were abdominal pain (50%), fever (46.1%), dyspnoea (30.7%) and cough (30.7%), and frequently reported laboratory findings were high absolute eosinophil count (38.4%), high white blood cell count (30.7%), high C-reactive protein (23.0%) and high neutrophil count (19.2%). Two of the 26 patients (7.7%) had fatal outcomes. Most of the SARS-CoV-2-Strongyloides coinfected cases were immigrants living in developed countries, emphasising the need for clinicians in these countries to be aware of clinical and laboratory parameters associated with such co-infections, as well as the key importance of rapid and accurate diagnostic tests for timely and effective diagnosis and patient management.
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Affiliation(s)
- Sana Zulfiqar
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Sahar Ghodsian
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mustafa Almukhtar
- Takhar Family Medicine and Urgent Care, Sacramento, California, United States
| | - Celia Holland
- Department of Zoology, School of Natural Sciences, Trinity College Dublin, the University of Dublin, College Green Dublin, Ireland
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Ashiri A, Beiromvand M, Rafiei A, Heidari R, Takesh A. Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas. Eur J Med Res 2023; 28:281. [PMID: 37563592 PMCID: PMC10416476 DOI: 10.1186/s40001-023-01262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fatal forms of strongyloidiasis, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), are caused by exaggerated autoinfection of the intestinal nematode, Strongyloides stercoralis (S. stercoralis). Corticosteroids, frequently administered to patients with severe COVID-19, can transform chronic asymptomatic strongyloidiasis into the above-mentioned fatal diseases. This study aimed to investigate the prevalence of strongyloidiasis in COVID-19 patients receiving corticosteroids in a hypoendemic region. METHODS The present cross-sectional study enrolled 308 COVID-19 patients admitted to two hospitals in Ahvaz and Abadan in the southwest of Iran between 2020 and 2022. A real-time reverse transcription polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) scan were employed to detect and monitor the disease's severity in the patients, respectively. All patients were evaluated for IgG/IgM against S. stercoralis using Enzyme-linked immunosorbent assay (ELISA) test. Subsequently, individuals with a positive ELISA test were confirmed using parasitological methods, including direct smear and agar plate culture (APC). RESULTS The patients were between 15 and 94 years old, with a mean age of 57.99 ± 17.4 years. Of the 308 patients, 12 (3.9%) had a positive ELISA test, while 296 (96.1%) had negative results. Three of the 12 patients with a positive ELISA result died, and three failed to provide a stool sample. To this end, only six cases were examined parasitologically, in which S. stercoralis larvae were observed in five patients. Significant differences were found between S. stercoralis infection with sex (p = 0.037) and age (p = 0.027). Binary regression analysis revealed that strongyloidiasis was positively associated with sex (odds ratio [OR]: 5.137; 95% confidence interval [CI]: 1.107-23.847), age (OR: 5.647; 95% CI 1.216-26.218), and location (OR: 3.254; 95% CI: 0.864-12.257). CONCLUSIONS Our findings suggest that screening for latent strongyloidiasis in COVID-19 patients in endemic areas using high-sensitivity diagnostic methods, particularly ELISA, before receiving suppressive drugs should be given more consideration.
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Affiliation(s)
- Alireza Ashiri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Molouk Beiromvand
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Heidari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ameneh Takesh
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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8
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Malakar S, Mathur A, Mishra P, Radha P, Krishnani N, Ghoshal UC. Malabsorption due to strongyloidiasis after high-dose steroid therapy for Coronavirus disease-19. Indian J Gastroenterol 2023:10.1007/s12664-023-01378-0. [PMID: 37470967 DOI: 10.1007/s12664-023-01378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Sayan Malakar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Akash Mathur
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Piyush Mishra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Paturu Radha
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Narender Krishnani
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
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Al Busaidi N, Al Farsi F, Al Batashi H, Kashoub MS, Al Sinani A, Al Balushi Z, Khamis F. Steroid-induced Strongyloidiasis with Cholestasis Post-COVID-19 Pneumonia. Oman Med J 2023; 38:e534. [PMID: 37593525 PMCID: PMC10427783 DOI: 10.5001/omj.2023.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 08/19/2023] Open
Abstract
The use of immunosuppressive agents has recently been raised during the COVID-19 pandemic to manage the COVID-19-induced systemic inflammatory response and improve mortality. This widespread use of steroids and other immunomodulators for severe COVID-19 diseases might pose a potential risk of reactivation of latent diseases and the emergence of opportunistic infections such as strongyloidiasis. We report a case of strongyloidiasis with cholestasis in a middle-aged man; who was otherwise healthy and had no history of recent travel, developed three weeks after a prolonged course of steroids for the management of severe COVID-19 pneumonia. The patient was managed with a combination of albendazole and ivermectin. A high index of suspicion of strongyloidiasis in symptomatic patients post immunosuppressant therapy for severe COVID-19 is required to prevent unfavorable outcomes. In selected high-risk patients, post prolonged steroid therapy for COVID-19 pneumonia screening for strongyloidiasis and ivermectin empirical treatment might be considered even in non-endemic areas.
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Affiliation(s)
- Noora Al Busaidi
- Medical Microbiology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Fatma Al Farsi
- Medical Microbiology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Huda Al Batashi
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Masoud Salim Kashoub
- Internal Medicine Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Ahmed Al Sinani
- Acute Medicine Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Zakariya Al Balushi
- Infectious Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
| | - Faryal Khamis
- Infectious Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman
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Al-kuraishy HM, Al-Gareeb AI, Alkazmi L, El-Bouseary MM, Hamad RS, Abdelhamid M, Batiha GES. The Potential Nexus between Helminths and SARS-CoV-2 Infection: A Literature Review. J Immunol Res 2023; 2023:5544819. [PMID: 37383608 PMCID: PMC10299886 DOI: 10.1155/2023/5544819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/05/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Chronic helminth infections (CHIs) can induce immunological tolerance through the upregulation of regulatory T cells. In coronavirus disease 2019 (COVID-19), abnormal adaptive immune response and exaggerated immune response may cause immune-mediated tissue damage. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and CHIs establish complicated immune interactions due to SARS-CoV-2-induced immunological stimulation and CHIs-induced immunological tolerance. However, COVID-19 severity in patients with CHIs is mild, as immune-suppressive anti-inflammatory cytokines counterbalance the risk of cytokine storm. Since CHIs have immunomodulatory effects, therefore, this narrative review aimed to clarify how CHIs modulate the immunoinflammatory response in SARS-CoV-2 infection. CHIs, through helminth-derived molecules, may suppress SARS-CoV-2 entry and associated hyperinflammation through attenuation of the inflammatory signaling pathway. In addition, CHIs may reduce the COVID-19 severity by reducing the SARS-CoV-2 entry points in the initial phase and immunomodulation in the late phase of the disease by suppressing the release of pro-inflammatory cytokines. In conclusion, CHIs may reduce the severity of SARS-CoV-2 infection by reducing hyperinflammation and exaggerated immune response. Thus, retrospective and prospective studies are recommended in this regard.
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Affiliation(s)
- Hayder M. Al-kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Ali I. Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | - Luay Alkazmi
- Biology Department, Faculty of Applied Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Maisra M. El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Rabab S. Hamad
- Biological Sciences Department, College of Science, King Faisal University, Al Ahsa 31982, Saudi Arabia
- Central Laboratory, Theodor Bilharz Research Institute, Giza 12411, Egypt
| | - Mahmoud Abdelhamid
- Department of Parasitology, Faculty of Veterinary Medicine, Aswan University, Aswan 81528, Egypt
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, AlBeheira, Egypt
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11
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Rosca EC, Heneghan C, Spencer EA, Plüddemann A, Maltoni S, Gandini S, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Coinfection with Strongyloides and SARS-CoV-2: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8050248. [PMID: 37235296 DOI: 10.3390/tropicalmed8050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Treatments for COVID-19, including steroids, might exacerbate Strongyloides disease in patients with coinfection. We aimed to systematically review clinical and laboratory features of SARS-CoV-2 and Strongyloides coinfection, investigate possible interventions, assess outcomes, and identify research gaps requiring further attention. METHODS We searched two electronic databases, LitCOVID and WHO, up to August 2022, including SARS-CoV-2 and Strongyloides coinfection studies. We adapted the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system for standardized case causality assessment to evaluate if using corticosteroids or other immunosuppressive drugs in COVID-19 patients determined acute manifestations of strongyloidiasis. RESULTS We included 16 studies reporting 25 cases of Strongyloides and SARS-CoV-2 coinfection: 4 with hyperinfection syndrome; 2 with disseminated strongyloidiasis; 3 with cutaneous reactivation of strongyloidiasis; 3 with isolated digestive symptoms; and 2 with solely eosinophilia, without clinical manifestations. Eleven patients were asymptomatic regarding strongyloidiasis. Eosinopenia or normal eosinophil count was reported in 58.3% of patients with Strongyloides reactivation. Steroids were given to 18/21 (85.7%) cases. A total of 4 patients (19.1%) received tocilizumab and/or Anakirna in addition to steroids. Moreover, 2 patients (9.5%) did not receive any COVID-19 treatment. The causal relationship between Strongyloides reactivation and COVID-19 treatments was considered certain (4% of cases), probable (20% of patients), and possible (20% of patients). For 8% of cases, it was considered unlikely that COVID-19 treatment was associated with strongyloidiasis reactivations; the relationship between the Strongyloides infection and administration of COVID-19 treatment was unassessable/unclassifiable in 48% of cases. Of 13 assessable cases, 11 (84.6%) were considered to be causally associated with Strongyloides, ranging from certain to possible. CONCLUSIONS Further research is needed to assess the frequency and risk of Strongyloides reactivation in SARS-CoV-2 infection. Our limited data using causality assessment supports recommendations that clinicians should screen and treat for Strongyloides infection in patients with coinfection who receive immunosuppressive COVID-19 therapies. In addition, the male gender and older age (over 50 years) may be predisposing factors for Strongyloides reactivation. Standardized guidelines should be developed for reporting future research.
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Affiliation(s)
- Elena C Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, 300041 Timisoara, Romania
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Elizabeth A Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Annette Plüddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Susanna Maltoni
- Division of Research and Innovation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Igho J Onakpoya
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| | - David Evans
- Li Ka Shing Institute of Virology and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 1N4, Canada
| | - Tom Jefferson
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
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12
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Strongyloides and COVID-19: Challenges and Opportunities for Future Research. Trop Med Infect Dis 2023; 8:tropicalmed8020127. [PMID: 36828543 PMCID: PMC9967524 DOI: 10.3390/tropicalmed8020127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.
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Leatherman JW, Prekker ME, Kummer RL, Maurer JL, Beacom EJ, Ahiskali AS, Shapiro RS. Ventilatory Parameters Measured After One Week of Mechanical Ventilation and Survival in COVID-19-Related ARDS. Respir Care 2023; 68:44-51. [PMID: 36318980 PMCID: PMC9993523 DOI: 10.4187/respcare.10029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Ventilatory parameters measured soon after initiation of mechanical ventilation have limited ability to predict outcome of COVID-19-related ARDS. We hypothesized that ventilatory parameters measured after one week of mechanical ventilation might differ between survivors and non-survivors. METHODS One hundred twenty-seven subjects with COVID-related ARDS had gas exchange and lung mechanics assessed on the day of intubation and one week later. The main parameters of interest were PaO2 /FIO2 , ventilatory ratio (VR), respiratory system compliance (CRS), and a composite score that was calculated as (PaO2 /FIO2 /100) × CRS/VR. The primary outcome was death in the ICU. RESULTS Of the 127 subjects, 42 (33%) died in the ICU and 85 (67%) were successfully extubated. On the day of intubation, PaO2 /FIO2 , CRS, and composite score of survivors and non-survivors were similar, but survivors had a lower VR. At one week, as compared to survivors, non-survivors had a significantly higher VR (2.04 ± 0.76 vs 1.60 ± 0.43, P < .001), lower CRS (27.4 ± 6.4 mL/cm H2O vs 32.4 ± 9.3 mL/cm H2O, P = .002), and lower composite score (20.6 ± 11.9 vs 34.5 ± 18.6, P < .001), with no statistically significant difference in PaO2 /FIO2 (137 ± 49 vs 155 ± 48, P = .08). CONCLUSIONS In subjects with COVID ARDS, parameters that reflect dead space (VR), lung mechanics (CRS), and a combined score that included PaO2 /FIO2 , VR, and CRS differed between survivors and non-survivors after one week of mechanical ventilation but with considerable overlap of values between survivors and non-survivors.
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Affiliation(s)
- James W Leatherman
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota.
| | - Matthew E Prekker
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota
| | - Rebecca L Kummer
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - John L Maurer
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Evan J Beacom
- Internal Medicine Residency Program, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Aileen S Ahiskali
- Department of Pharmacy, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Robert S Shapiro
- Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; and the University of Minnesota, Minneapolis, Minnesota
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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:411-412. [PMID: 35624067 PMCID: PMC9574943 DOI: 10.1016/j.eimce.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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Rodríguez-Guardado A, Álvarez-Martínez MJ, Flores MD, Sulleiro E, Torrús-Tendero D, Velasco M, Membrillo FJ. Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: Results of a survey on diagnosis and treatment. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00174-5. [PMID: 35970704 PMCID: PMC9372776 DOI: 10.1016/j.eimce.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/31/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022]
Abstract
Introduction The generalization of treatment with dexamethasone or other immunosuppressants in patients with SARS-CoV-2 infection may increase the risk of occurrence of severe forms of strongyloidiasis. A nationwide survey was conducted to better understand the diagnostic and therapeutic situation of strongyloidiasis in SARS-CoV-2 co-infected patients in Spain. Materials and methods A survey was designed and sent to all SEIMC members during February and March 2021. Responses were exported for computer processing to Microsoft Excel 2017 and statistically processed with the free software PSPP. Results 189 responses were received, of which 121 (64%) were selected for further processing. Eighty-four centers (69.5%) had no specific strongyloidiasis screening protocol. Forty-two centers (34.7%) had serological techniques available in their laboratories and the rest were sent to a reference laboratory. Only 22 centers (18%) screened for strongyloidiasis in SARS-CoV-2 infected patients. A total of 227 cases of strongyloidiasis were diagnosed in patients with SARS-CoV-2 infection. In four cases patients developed a massive hyperinfestation syndrome leading to the death of one patient. Conclusion COVID-19 has highlighted the need to unify screening and treatment protocols for imported pathologies such as strongyloidiosis. Efforts to disseminate knowledge are needed to ensure that this potentially fatal disease is adequately treated in patients with the highest risk of complications, such as those with COVID-19.
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Katal S, Eibschutz LS, Radmard AR, Naderpour Z, Gupta A, Hejal R, Gholamrezanezhad A. Black Fungus and beyond: COVID-19 associated infections. Clin Imaging 2022; 90:97-109. [PMID: 36007282 PMCID: PMC9308173 DOI: 10.1016/j.clinimag.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
Globally, many hospitalized COVID-19 patients can experience an unexpected acute change in status, prompting rapid and expert clinical assessment. Superimposed infections can be a significant cause of clinical and radiologic deviations in this patient population, further worsening clinical outcome and muddling the differential diagnosis. As thrombotic, inflammatory, and medication-induced complications can also trigger an acute change in COVID-19 patient status, imaging early and often plays a vital role in distinguishing the cause of patient decline and monitoring patient outcome. While the common radiologic findings of COVID-19 infection are now widely reported, little is known about the clinical manifestations and imaging findings of superimposed infection. By discussing case studies of patients who developed bacterial, fungal, parasitic, and viral co-infections and identifying the most frequently reported imaging findings of superimposed infections, physicians will be more familiar with common infectious presentations and initiate a directed workup sooner. Ultimately, any abrupt changes in the expected COVID-19 imaging presentation, such as the presence of new consolidations or cavitation, should prompt further workup to exclude superimposed opportunistic infection.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine, Shiraz Kowsar Hospital, Tehran University of Medical Sciences
| | - Liesl S Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Zeinab Naderpour
- Department of Pulmonology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Amit Gupta
- Department of Radiology, University Hospital Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rana Hejal
- Department of Internal Medicine, Division of Pulmonary Critical Care, University Hospital Cleveland Medical Center, Cleveland, OH, United States of America
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America.
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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. [Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis]. Enferm Infecc Microbiol Clin 2022; 40:411-412. [PMID: 35469335 PMCID: PMC9020610 DOI: 10.1016/j.eimc.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Philip Wikman-Jorgensen
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, España
| | - Ana Requena-Méndez
- Instituto de Salud Global de Barcelona (ISGlobal, Hospital Clinic-University of Barcelona), Barcelona, España.,Department of Medicine Solna, Karolinska Institutet, Solna, Suecia
| | - Miriam Navarro
- Unidad de Epidemiología, Centro de Salud Pública de Elche, Alicante, España.,Departamento de Salud Pública, Historia de la Ciencia y Ginecología; Universidad Miguel Hernández de Elche, Alicante, España
| | - Jara Llenas-García
- Servicio de Medicina Interna/infecciosas, Hospital Vega Baja-FISABIO, Alicante, España.,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
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Maslove DM, Sibley S, Boyd JG, Goligher EC, Munshi L, Bogoch II, Rochwerg B. Complications of Critical COVID-19: Diagnostic and Therapeutic Considerations for the Mechanically Ventilated Patient. Chest 2022; 161:989-998. [PMID: 34655568 PMCID: PMC8511547 DOI: 10.1016/j.chest.2021.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/04/2021] [Accepted: 10/06/2021] [Indexed: 01/31/2023] Open
Abstract
Patients admitted to the ICU with critical COVID-19 often require prolonged periods of mechanical ventilation. Difficulty weaning, lack of progress, and clinical deterioration are commonly encountered. These conditions should prompt a thorough evaluation for persistent or untreated manifestations of COVID-19, as well as complications from COVID-19 and its various treatments. Inflammation may persist and lead to fibroproliferative changes in the lungs. Infectious complications may arise including bacterial superinfection in the earlier stages of disease. Use of immunosuppressants may lead to the dissemination of latent infections, and to opportunistic infections. Venous thromboembolic disease is common, as are certain neurologic manifestations of COVID-19 including delirium and stroke. High levels of ventilatory support may lead to ventilator-induced injury to the lungs and diaphragm. We present diagnostic and therapeutic considerations for the mechanically ventilated patient with COVID-19 who shows persistent or worsening signs of critical illness, and we offer an approach to treating this complex but common scenario.
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Affiliation(s)
- David M. Maslove
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada,Kingston Health Sciences Centre, Kingston, ON, Canada,CORRESPONDENCE TO: David M. Maslove, MD
| | - Stephanie Sibley
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - J. Gordon Boyd
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada,Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada,University Health Network, Toronto, ON, Canada
| | - Laveena Munshi
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada,Sinai Health System, Toronto, ON, Canada
| | - Isaac I. Bogoch
- University Health Network, Toronto, ON, Canada,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada,Juravinski Hospital, Hamilton, ON, Canada
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[Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: results of a survey on diagnosis and treatment]. Enferm Infecc Microbiol Clin 2021:S0213-005X(21)00386-4. [PMID: 34931102 PMCID: PMC8673747 DOI: 10.1016/j.eimc.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022]
Abstract
Introducción La generalización del tratamiento con dexametasona u otros inmunosupresores en pacientes con infección por SARS-CoV-2 puede aumentar el riesgo de aparición de formas graves de estrongiloidiosis. Se realizó una encuesta a nivel nacional para conocer mejor de la situación diagnóstica y terapéutica de la estrongiloidiosis en España en pacientes coinfectados por SARS-CoV-2. Materiales y métodos Se diseñó una encuesta que fue enviada a todos los miembros de SEIMC durante los meses de febrero y marzo de 2021. Las respuestas se exportaron para su procesamiento informático al programa Microsoft Excel 2017 y se procesaron estadísticamente con el software libre PSPP. Resultados Se recibieron 189 respuestas, de las cuales se seleccionaron 121 (64%) para su procesamiento posterior. En 84 centros (69,5%) no existía ningún protocolo de cribado específico de estrongiloidiosis. Cuarenta y dos centros (34,7%) disponían de técnicas serológicas en sus laboratorios y en el resto se enviaban a un laboratorio de referencia. Solo 22 centros (18%) realizaron cribado de estrongiloidiosis en pacientes infectados por SARS-CoV-2. Se diagnosticaron 227 casos de estrongiloidiosis en pacientes con infección por el SARS-CoV-2. En cuatro casos los pacientes desarrollaron un síndrome de hiperinfestación masiva que condujo al fallecimiento de uno. Conclusión La COVID-19 ha puesto de manifiesto la necesidad de unificar protocolos de cribado y tratamiento de patologías importadas como la estrongiloidiosis. Es necesario realizar un esfuerzo de difusión del conocimiento para que esta patología potencialmente mortal sea tratada adecuadamente en los pacientes con mayor riesgo de complicaciones, como son aquellos con COVID-19.
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A Practical Approach to Screening for Strongyloides stercoralis. Trop Med Infect Dis 2021; 6:tropicalmed6040203. [PMID: 34941659 PMCID: PMC8704417 DOI: 10.3390/tropicalmed6040203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
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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Lorenzo H, Carbonell C, Vicente Santiago MB, López-Bernus A, Pendones Ulerio J, Muñoz Bellido JL, Muro A, Belhassen-García M. Influence of the drugs used in migrant patients with severe acute respiratory syndrome coronavirus 2 and the development of symptomatic strongyloidiasis. Trans R Soc Trop Med Hyg 2021; 116:440-445. [PMID: 34614186 PMCID: PMC8500139 DOI: 10.1093/trstmh/trab152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background The use of dexamethasone in patients infected with Strongyloides stercoralis can cause severe complications. It is necessary to investigate the relationship between coronavirus disease 2019 (COVID-19) and strongyloidiasis infection. Methods A retrospective, longitudinal, descriptive study was undertaken to review all patients admitted with a diagnosis of COVID-19 infection at the Complejo Asistencial Universitario de Salamanca, Spain, during 1 March–31 December 2020. Results A total of 2567 patients received a diagnosis of COVID-19. Eighty-six patients from endemic areas were included. Seven patients had strongyloidiasis. Five patients were female. The mean age (±SD) was 39 (±10.8) y. Six patients were Latin-American and only one patient was from Africa. Six patients had previous symptoms compatible with strongyloidiasis infections. Only three patients received dexamethasone (6 mg once daily) for 10 d. In all cases, the clinical courses of the patients were satisfactory. No patient died or was admitted to the ICU. Conclusions Screening programmes using serological techniques should be implemented in COVID-19 patients to prevent strongyloidiasis. Our study suggested that drugs used against COVID-19 in patients with strongyloidiasis did not affect the evolution of the disease. However, more studies are necessary to elucidate the role of dexamethasone in COVID-19 patients infected with Strongyloides.
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Affiliation(s)
- Helena Lorenzo
- Servicio de Microbiología y Parasitología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca 37007, Spain
| | - Cristina Carbonell
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain
| | - María Belén Vicente Santiago
- Infectious and Tropical Diseases Group (e-INTRO), CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca 37007, Spain
| | - Amparo López-Bernus
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, CIETUS, IBSAL, Salamanca 37007, Spain
| | | | - Juan Luis Muñoz Bellido
- Servicio de Microbiología y Parasitología, CAUSA, CIETUS, IBSAL, Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, CSIC, Salamanca 37007, Spain
| | - Antonio Muro
- e-INTRO, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca 37007, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, e-INTRO, CIETUS, IBSAL, Salamanca 37007, Spain
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Pereira CVM, Mastandrea GRA, Medeiros ACCDS, Gryschek RCB, de Paula FM, Corral MA. COVID-19 and strongyloidiasis: what to expect from this coinfection? Clinics (Sao Paulo) 2021; 76:e3528. [PMID: 34817048 PMCID: PMC8579849 DOI: 10.6061/clinics/2021/e3528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | - Ronaldo Cesar Borges Gryschek
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabiana Martins de Paula
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Andreetta Corral
- Faculdade de Medicina, Universidade Santo Amaro, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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