Table 1.
The characteristics of included cases.
| Study | Age | Gender | Underlying Diseases | Strongyloides Infection Manifestation | Strongyloides Infection Diagnosis | COVID-19 Diagnosis | Laboratory Findings | COVID-19 Treatment | Strongyloides Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
| Alian 2022 [25] | 73 | Female | Chronic kidney disease, diabetes mellitus, hypertension, dyslipidemia. | Mucormycosis. No strongyloidiasis manifestations. | Stool analysis | N/R | Lymphocytes decreased | Dexamethasone (8 mg daily) Remdesevir. |
N/R | Death |
| Babazadeh 2022 [26] | 70 | Male | Mitral valve replacement, atrial fibrillation, heart failure. | HS | Histopathologic examination (gastric and duodenal mucosae) | N/R | Lymphocytes normal Eosinophils increased |
Dexamethasone (6 mg/day iv, 10 days). | Ivermectin (200 μg/kg for 7 days) Albendazole (400 mg every 12 h for 10 days) |
Remission of symptoms |
| Feria 2022, case 1 [27] | 44 | Male | Smoking, hypertension, obesity. | Cutaneous reactivation | Serology for S. stercoralis IgG (ELISA) | N/R | Eosinophils normal | Dexamethasone (6 mg/day, 7 days). | Ivermectin (200 mcg/kg/day for 2 days) | Resolution of the skin condition |
| Feria 2022, case 2 [27] | 74 | Female | Pyrazolone allergy, hypertension, dyslipidemia, chronic kidney disease, disseminated tuberculosis correctly treated. | Cutaneous reactivation | Serology for S. stercoralis IgG (ELISA) | N/R | Lymphocytes normal Eosinophils decreased |
Dexamethasone (6 mg/day, 10 days). | Ivermectin (200 mcg/kg/day for 2 days) | Resolution of the skin condition |
| Gautam 2021 [28] | 53 | Male | N/R | HS | Stool microscopic examination Koga agar plate |
N/R | Eosinophils normal | Methylprednisolone (60 mg iv, twice a day for 5 days). | Ivermectin Albendazole |
Recovery |
| Kim 2022 [29] | 63 | Male | Diabetes mellitus, alcohol use disorder. | HS | Microscopic examination of the bronchoalveolar lavage fluid Serology for S. stercoralis IgG Stool microscopic examination |
RT-PCR | Lymphocytes decreased Eosinophiles decreased |
Dexamethasone (6 mg/d for 10 days); Baricitinib (10 mg/day, for 5 days) Remdesivir (100 mg/day, for 5 days). |
Oral ivermectin (200 μg/kg for 14 days) | Death |
| Lier 2020 [30] | 68 | Male | Hypertension, diabetes mellitus complicated by peripheral neuropathy. | DS | Sputum culture Gram and iodine stains Strongyloides serum antibody Stool analysis |
RT-PCR | Lymphocytes normal Eosinophils decreased |
Methylprednisolone (40 mg iv every 8 h, 3 courses) Tocilizumab (once, iv at 8 mg/kg) Hydroxychloroquine (400 mg oral twice daily loading dose, then 200 mg oral twice daily for 5 days). |
Ivermectin (200 μg/kg daily). Albendazole (400 mg orally every 12 h, a 2-week course |
Improvement. Transferred to a skilled nursing facility |
| Lorenzo 2022, Patient 1 [31] | 37 | Female | Obesity, diabetes mellitus, dyslipidemia, previous strongyloidiasis (digestive symptoms, no cutaneous manifestations). | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | Dexamethasone (6 mg once daily for 10 days). | N/R | Recovery |
| Lorenzo 2022, Patient 2 [31] | 47 | Female | Chagas disease, previous strongyloidiasis (digestive symptoms, asthma, no cutaneous manifestations). | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | Dexamethasone (6 mg once daily, for 10 days) Remdesivir. |
N/R | Recovery |
| Lorenzo 2022, Patient 3 [31] | 33 | Female | Previous strongyloidiasis (digestive symptoms, asthma, no cutaneous manifestations). | Eosinophilia | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils increased | Dexamethasone (6 mg once daily, for 10 days) Remdesivir. |
N/R | Recovery |
| Lorenzo 2022, Patient 4 [31] | 38 | Male | Previous strongyloidiasis (asthma, no cutaneous manifestations). | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | Azithromycin Hydroxychloroquine Lopinavir/ritonavir. |
N/R | Recovery |
| Lorenzo 2022, Patient 5 [31] | 22 | Male | Crohn disease, previous strongyloidiasis (digestive symptoms, no cutaneous manifestations). | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | Azithromycin Hydroxychloroquine Lopinavir/ritonavir. |
N/R | Recovery |
| Lorenzo 2022, Patient 6 [31] | 69 | Female | Trigeminal neuralgia. | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | Azithromycin Hydroxychloroquine Lopinavir/ritonavir. |
N/R | Recovery |
| Lorenzo 2022, Patient 7 [31] | 27 | Female | Vitiligo, previous strongyloidiasis (digestive symptoms, no cutaneous manifestations). | None | Serology for S. stercoralis IgG (ELISA) | RT-PCR | Eosinophils normal | None. | N/R | Recovery |
| Marchese 2021 [32] | 59 | Female | Still’s disease, hypertension, repeated episodes of diffuse itching in the last 10 years, treated with topical steroids with partial improvement. | Digestive symptoms. | Stool examination IFAT serology |
RT-PCR | Eosinophils increased | Hydroxychloroquine Lopinavir/ritonavir Dexamethasone (20 mg/day for 5 days, followed by 10 mg/day for other 6 days) Tocilizumab 8 mg/kg, 2 doses, 12 h apart. |
Ivermectin (200 mcg/kg, oral, 4 days) | Improvement |
| Martinez 2021, 3/35 (9%) cases [33] | Average: 42.84 ± 11.38 years (among 35 patients) | 52% of women (among 35 patients) | N/R | None | Serology for S. stercoralis | N/R | Eosinophils normal | Among 35 cases: 83% dexamethasone 6 mg/24 h, 14% methylprednisolone bolus 250 mg, 12% tocilizumab 400 mg, and 3% no immunosuppressive treatment. | Prophylactic: ivermectin 6 mg/8 h for 2 days. | No Strongyloides infection manifestations |
| Nakandakaria 2021 [34] | 4 | Female | The parents were tested positive and treated for COVID-19 a month earlier. | None | Stool examination | COVID-19 Rapid Test (IgM, IgG) | Eosinophils increased | N/R | Ivermectin (1 drop/kg/day for 2 days) Metronidazole (40 mg/kg/day every 8 h). |
Recovery |
| Nunez-Gomez 2021 [35] | 45 | Male | Several episodes of suspected allergic reactions with rash and angioedema. The last episode occurred in 2018, and the trigger remained undetermined. | Cutaneous reactivation | Serology for S. stercoralis Stool Mueller-Hinton agar plate culture |
N/R | N/R | Dexamethasone (6 mg/day, for 12 days) | Ivermectin (200 mg/kg, for 14 days). | Improvement |
| O’Dowling 2022 [36] | 60 | Female | No significant past medical history. | HS | Serology for S. stercoralis Pathological analysis of the small bowel specimen |
N/R | N/R | None | Ivermectin (2 doses). | Improvement |
| Patel 2021 [37] | 72 | Male | N/R | DS | Stool microscopic examination Bronchoalveolar lavage Gram-stain |
RT-PCR | Eosinophils increased | Dexamethasone | Ivermectin. | Improvement |
| Pintos-Pascual 2021 [38] | 70 | Male | Hypertension | Digestive reactivation | Fresh stool analysis Serological test |
RT-PCR | Lymphocytes decreased Eosinophils normal |
Methylprednisolone (250 mg boluses, for 5 days, followed by dose tapering, ending treatment at one month) Tocilizumab (day 6 to day 13). Anakinra (on days 10–13 and 19–24). |
Albendazole (400 mg/12 h for 3 days) Ivermectin. |
Resolution of symptoms |
| Singh 2021 [39] | 58 | Male | Diabetes, rheumatoid arthritis. | Unclear. Ascariasis—S. stercoralis coinfection | Stool microscopic examination | RT-PCR | Lymphocytes decreased Eosinophils increased |
Methylprednisolone Aztreonam Hydroxychloroquine Favipiravir/remedesvir Azithromycin |
Ivermectin (200 μg/kg/day, 2 weeks) Albendazole (400 mg every 12 h, 2 weeks)—for Ascariasis coinfection. |
Improvement |
| Stylemans 2021 [40] | 59 | Male | Diabetes, smoking, chronic eosinophilia for 7 years. | Eosinophilia | Serology for S. stercoralis Molecular diagnosis of S. stercoralis in fresh fecal samples using RT-PCR |
RT-PCR | Eosinophils normal | Anakinra Methylprednisolone (80 mg, tapered over 1 month; from day 49 quick tapering from 16 mg to stop over 7 days). |
Ivermectin (single dose) | Recovery |
Notes: Hyperinfection syndrome: HS; disseminated strongyloidiasis: DS; reverse transcription polymerase chain reaction: RT-PCR. Not reported: N/R.