Clinical Characteristics of Strongyloidiasis during the Covid-19 Pandemic: Systematic Scoping Review

ABSTRACT

INTRODUCTION: Reactivation of Strongyloides stercoralis related to COVID-19 infection or treatment has been an emerging topic of interest, although characteristics of Strongyloides infection in COVID-19 patients are not yet well characterized. This study aims to summarize the existing evidence of Strongyloides infection in COVID-19 patients and figure out the future areas of research. METHOD(S) According to the PRISMA Extension for Scoping Reviews, we performed a search on MEDLINE and EMBASE for articles with keywords including"Strongyloides," "Strongyloidiasis," and "COVID-19," from the inception of these databases to June 5, 2022. RESULT(S) A total of 104 articles were found. After excluding duplication and thorough reviews, 11 articles, including two observational studies, one conference , and nine case reports or series, were included. Two observational studies focused on revealing the prevalence of Strongyloides screening in COVID-19 patients and clinical follow-up. One study from Spain, including 227 cases of COVID-19 and Strongyloides co-infection, noted that four patients developed critical hyperinfection leading to the expiration of one patient. Among the included cases, patients were mostly from low- or middle-income countries (LMICs) who suffered from severe or critical COVID-19. 90% received 6mg/day dexamethasone for 7-10 days or higher prednisone-equivalent doses of corticosteroids. 60% and 20% had Strongyloides hyperinfection and disseminated infection, respectively. Interestingly, patients had either eosinopenia or normal eosinophil counts while they were treated for COVID-19, and they were likely to develop eosinophilia later in the course leading to the diagnosis of Strongyloidiasis. CONCLUSION(S) This systematic review summarizes the clinical characteristics of Strongyloidiasis in COVID-19 infection. Likely due to COVID-19-related eosinopenia and the effect of corticosteroids, patients may not necessarily have overt eosinophilia despite the parasitic infection. Developing a Strongyloides screening strategy for COVID-19 patients based on patients' demographics and origins may help diagnose the condition. While further studies to identify risks and precipitants associated with the onset of Strongyloidiasis in crucial, increased awareness of the critical condition is warranted.