Epidemiological and clinical profile of immunosuppressed patients with imported strongyloidiasis: a substudy from a larger cohort of the +REDIVI Spanish Collaborative Network

Prediction of helminthiases in travellers and migrants with eosinophilia: a cohort study

OBJECTIVES

The aim of this study was to determine predictors for helminthiasis among travellers and migrants with eosinophilia for which a visto to tropical regions or endemic regions for common helminthiasis had been registered.

METHODS

A retrospective cohort study was performed using electronic health records of 23,905 patients with eosinophilia (January-2011 to August-2021) at Karolinska University Hospital, (Stockholm), including patients tested for helminthiasis with a registered stay in a helminth endemic region. Outcomes were diagnosis of any helminthiasis, and diagnosis of schistosomiasis and strongyloidiasis. Multivariable logistic regression was used to assess associations between potential predictors and helminthiases with a backwards stepwise elimination approach until a predictive model was reached in which each variable had a p-value<0.15.

RESULTS

Of 1,112 eligible patients with eosinophilia and documented stay in endemic regions, 219 (19.7%) had been diagnosed with helminthiasis, most frequently schistosomiasis (n=95, 43.4%) and strongyloidiasis (n=64, 29.2%). A stay in Sub-Saharan Africa (SSA),(OR 8.2 [95%CI 2.44-27.56]), malaise and fatigue (OR 2.65 [0.77-9.09]) and high-grade eosinophilia >1500cells/μl, (2.26, [1.54-3.32]) were the most important predictors for any helminthiasis (AUC: 0.77 [0.74-0.80). A SSA origin (2.97 [1.11-7.95]), malaise and fatigue (5.48 (1.13-26.63) and high-grade eosinophilia, (1.53, [0.86-2.71]) were predictors for schistosomiasis (AUC: 0.74 [0.70-0.77]; whereas SSA origin (5.68 [3.04-10.59]), itching symptom (5.05 [1.32-19.36], and high-grade eosinophilia (2.42, [1.33-4.41]) were predictors for strongyloidiasis (AUC: 0.73 [0.69-0.76]).

CONCLUSIONS

A stay in an endemic region, specifically SSA, having high-grade eosinophilia, and malaise and fatigue were the most important predictors for helminthiasis. Itching was an additional predictor for strongyloidiasis.

Human Strongyloides stercoralis infection

Strongyloides stercoralis is an important soil-transmitted helminth occurring world-wide and affecting 30-100 million people. Because many cases are asymptomatic and sensitive diagnostic methods are lacking, S. stercoralis infection is frequently underdiagnosed. The increasing incidence of autoimmune and wasting diseases and increased use of immunosuppressive agents, as well as the increased use of immunosuppressants and cytotoxic drugs, have increased S. stercoralis infection and their mortality. This review provides information about S. stercoralis epidemiology, life cycle, aetiology, pathology, comorbidities, immunology, vaccines, diagnosis, treatment, prevention, control and makes some recommendations for future prevention and control of this important parasite.

Strongyloidiasis-related lung involvement: too much of a bad thing

PURPOSE OF REVIEW

Strongyloidiasis is a soil-transmitted helminthiasis, a neglected tropical disease that affects 300-900 million individuals globally. Strongyloides stercoralis is associated with cutaneous, respiratory, and gastrointestinal clinical manifestations. Chronicity is due to an autoinfective cycle, and host immunosuppression can lead to severe and fatal disease. Lung involvement is significant in severe strongyloidiasis, and Strongyloides has a complex association with a number of lung diseases, which will be discussed in this review.

RECENT FINDINGS

The treatment of chronic lung diseases such as asthma and chronic obstructive pulmonary disease with corticosteroids is an important risk factor for Strongyloides hyperinfection syndrome (SHS)/disseminated strongyloidiasis. The use of corticosteroids in the treatment of coronavirus disease 2019 (COVID-19) and potentially COVID-19-induced eosinopenia are risk factors for severe strongyloidiasis. Recent findings have demonstrated a significant immunomodulatory role of Strongyloides in both latent and active pulmonary tuberculosis associated to an impaired immune response and poor outcomes in active pulmonary tuberculosis.

SUMMARY

Strongyloides lung involvement is a common finding in severe infection. Prompt recognition of Strongyloides infection as well as prevention of severe disease by screening or presumptive treatment are important goals in order to improve Strongyloides outcomes in at-risk population.

Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: Results of a survey on diagnosis and treatment

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.

[Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: results of a survey on diagnosis and treatment]

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.

Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol

Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.