Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia

Infection. 2021 Jun;49(3):539-542. doi: 10.1007/s15010-020-01522-4. Epub 2020 Sep 10.

Abstract

Background: SARS-CoV-2 pandemic has posed formidable public health and clinical challenges. The use of immunosuppressive agents, such as high dose corticosteroids and cytokine inhibitors (e.g., Tocilizumab) has been suggested to contrast the hyperinflammatory process involved in the pathogenesis of the severe disease, with conflicting evidence. Among the drawbacks of immunosuppressive therapy, the risk of reactivation of latent infections, including parasitic infestations, is to be considered.

Case presentation: We report a case of a 59-year-old Italian patient treated with high dose intravenous dexamethasone and two intravenous doses of Tocilizumab for interstitial bilateral pneumonia associated with SARS-CoV-2 infection who developed itching, abdominal pain, and an increased eosinophil count. Stool examination confirmed the presence of S. stercoralis larvae. The patient was treated with a 4-day course of Ivermectin with full recovery.

Discussion: We report the first case of S. stercoralis infection following an 11-day treatment with high-dose steroids and Tocilizumab for severe COVID-19. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19.

Keywords: Immunosuppression; SARS-CoV-2; Strongyloides stercoralis; Tocilizumab.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antiparasitic Agents / therapeutic use
  • COVID-19 / complications
  • COVID-19 / drug therapy*
  • Dexamethasone / adverse effects
  • Feces / parasitology
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Ivermectin / therapeutic use
  • Latent Infection / diagnosis
  • Latent Infection / drug therapy
  • Latent Infection / etiology*
  • Middle Aged
  • SARS-CoV-2
  • Strongyloides stercoralis / isolation & purification
  • Strongyloidiasis / diagnosis
  • Strongyloidiasis / drug therapy
  • Strongyloidiasis / etiology*
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiparasitic Agents
  • Immunosuppressive Agents
  • Ivermectin
  • Dexamethasone
  • tocilizumab

Supplementary concepts

  • COVID-19 drug treatment