ABSTRACT

Strongyloides stercoralis hyperinfection syndrome has been observed in immunosuppressed coronavirus disease 2019 (COVID-19) patients. Detecting and treating asymptomatic Strongyloides infection in individuals from endemic areas can effectively prevent hyperinfection. Unfortunately, many clinicians are unaware of this neglected infection. Therefore, we aimed to evaluate whether including Strongyloides screening in COVID-19 management protocols would encourage this practice. To accomplish this, we conducted a retrospective single-center study at ‘Hospital Universitario 12 de Octubre’ in Madrid, Spain, comparing two consecutive cohorts. The first cohort comprised all Latinx patients over 18 years old who were admitted for COVID-19 between March 1^st and April 30^th, 2020. The second cohort consisted of Latinx patients admitted between July 1^st and December 31^st, 2020, following an amendment to the COVID-19 management protocol that recommended screening for strongyloidiasis in at-risk patients. We identified 559 and 795 patients in the first and second periods, respectively. The percentage of individuals screened increased significantly from 8.8% to 51.6% after the screening recommendation was included in the protocol (odds ratio [OR] 11.08, 95% confidence interval [CI] 8.01–15.33). In both periods, the screening rate was significantly higher among those receiving immunosuppression than those who did not receive steroids and/or tocilizumab. No other factors influenced the screening rate. In conclusion, including strongyloidiasis screening recommendations in COVID-19 management protocols led to its increased implementation. However, the overall screening rate remained low, emphasizing the need for further efforts to enhance screening practices.

摘要

在免疫抑制的 2019 年冠状病毒病 (COVID-19) 患者中观察到粪类圆线虫过度感染综合征。对来自流行地区的无症状类圆线虫感染进行检测和治疗可以有效预防过度感染。不幸的是，许多临床医生没有意识到这种被忽视的感染。因此，我们的目的是评估将类圆线虫筛查纳入 COVID-19 管理方案是否会鼓励这种做法。为了实现这一目标，我们在西班牙马德里的“Hospital Universitario 12 de Octubre”进行了一项回顾性单中心研究，比较了两个连续队列。^{第一个队列包括 2020 年 3 月 1日}至 4 月 30^日期间因 COVID-19 入院的所有 18 岁以上拉丁裔患者。第二个队列包括 2020 年 7 月 1日^至12 月 31^日期间入院的拉丁裔患者。对 COVID-19 管理方案的修订建议对高危患者进行类圆线虫病筛查。我们在第一阶段和第二阶段分别识别了 559 名和 795 名患者。将筛查建议纳入方案后，筛查个体的百分比从 8.8% 显着增加至 51.6%（比值比 [OR] 11.08，95% 置信区间 [CI] 8.01–15.33）。在这两个时期，接受免疫抑制的患者的筛查率均显着高于未接受类固醇和/或托珠单抗的患者。没有其他因素影响筛查率。总之，将类圆线虫病筛查建议纳入 COVID-19 管理方案后，其实施得到了加强。然而，总体筛查率仍然较低，强调需要进一步努力加强筛查实践。