Parasitic Infection Can Turn Fatal With Corticosteroid Administration
The parasitic infection Strongyloides stercoralis can become fatal if a patient is administered corticosteroids. This risk is highlighted during the COVID-19 pandemic where these steroids are used as a treatment.
Awareness of the risks associated with administering corticosteroids to patients with the dangerous parasitic infection strongyloidiasis has been emphasized. The World Health Organization (WHO) highlighted in December 2020 that healthcare workers in tropical and subtropical regions, or those caring for patients who have traveled to such areas, must be aware of the potentially fatal consequences.
Strongyloidiasis, acquired through contact with contaminated soil, is estimated to affect millions globally, often within marginalized communities. While the infection is frequently asymptomatic, immunosuppression resulting from conditions like AIDS, lymphoma, leukemia, or prolonged corticosteroid use can lead to a severe and deadly "hyperinfection" syndrome.
The COVID-19 pandemic has brought the risks of corticosteroid use to the forefront. While corticosteroids have been shown to improve mortality in COVID-19 patients, this treatment can trigger hyperinfection in individuals with a concurrent, untreated strongyloidiasis infection. Beyond the pandemic, the use of corticosteroids has also increased in treating chronic conditions such as asthma and rheumatic diseases, broadening the at-risk population.
Preventive measures are crucial. Despite potential limitations in diagnostic tools in some regions, high clinical awareness is essential. In the U.S., presumptive treatment with ivermectin has been implemented for refugees from endemic areas. Guidance on presumptive treatment for at-risk populations has also been issued by Canada and the European Centre for Disease Prevention and Control. Inclusion of ivermectin in mass drug administration programs should also be considered.