Coinfection with Strongyloides and SARS-CoV-2: A Systematic Review

Area of Science:

• Infectious Diseases
• Parasitology
• Virology

Background:

• Coinfection with SARS-CoV-2 and Strongyloides stercoralis presents unique clinical challenges.
• Immunosuppressive treatments for COVID-19, particularly corticosteroids, may trigger or exacerbate Strongyloides hyperinfection syndrome or disseminated disease.

Purpose of the Study:

• To systematically review the clinical and laboratory features of SARS-CoV-2 and Strongyloides coinfection.
• To investigate potential interventions and assess outcomes in coinfected patients.
• To identify research gaps concerning the interplay between COVID-19 treatments and Strongyloides reactivation.

Main Methods:

• A systematic literature search was conducted on LitCOVID and WHO databases up to August 2022.
• The World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system was adapted for causality assessment of Strongyloides reactivation linked to COVID-19 treatments.
• Included studies reported cases of SARS-CoV-2 and Strongyloides coinfection.

Main Results:

• 16 studies reported 25 cases, including hyperinfection syndrome, disseminated strongyloidiasis, and cutaneous reactivation.
• 11 patients (44%) were asymptomatic for Strongyloides, and 58.3% with reactivation had eosinopenia or normal eosinophil counts.
• Causality assessment indicated a probable or possible link between COVID-19 treatments (steroids, tocilizumab, anakinra) and Strongyloides reactivation in 44% of assessable cases.

Conclusions:

• Further research is essential to determine the frequency and risk of Strongyloides reactivation in SARS-CoV-2 infected individuals.
• Clinical guidelines should recommend screening and treatment for Strongyloides in coinfected patients receiving immunosuppressive COVID-19 therapies.
• Male gender and age over 50 may predispose individuals to Strongyloides reactivation; standardized reporting guidelines are needed.