Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia
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CASE REPORT
Strongyloides infection manifested during immunosuppressive therapy for SARS‑CoV‑2 pneumonia Valentina Marchese1 · Verena Crosato2 · Maurizio Gulletta3 · Filippo Castelnuovo3 · Graziella Cristini3 · Alberto Matteelli4 · Francesco Castelli5 Received: 28 July 2020 / Accepted: 1 September 2020 © The Author(s) 2020
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 Strongyloides stercoralis · Tocilizumab · SARS-CoV-2 · Immunosuppression
Background
* Valentina Marchese [email protected] 1
Specialist Consultation Service ASST Spedali Civili; University Division of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili Hospital, Brescia, Italy
2
University Department of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili Hospital, Brescia, Italy
3
University Division of Infectious and Tropical Diseases, ASST Spedali Civili Hospital, Brescia, Italy
4
University Division of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili, Brescia, Italy
5
University Division of Infectious and Tropical Diseases, University of Brescia, ASST Spedali Civili Hospital, Brescia, Italy
The recent emergence of SARS-CoV-2 and its rapid spread throughout all continents has become a global concern [1]. Many studies have recently been conducted to identify the molecular pathway leading to alveolar damage in moderate and severe Coronavirus disease 2019 (COVID-19), and have shown the pivotal role of the hyperinflammatory response of the patients’ immune system to the virus in determining alveolar destruction [2]. This is the rationale for the use of corticosteroids, to counteract respiratory failure in severely ill patients, along with oxygen supply [3]. Clinical observational studies have described an improvement in clinical symptoms and oxygenation after steroid administrat
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