Strongyloidiasis in the COVID era: a warning for an implementation of the screening protocol

We read with extreme interest the recent case report by Marchese et al. concerning the manifestation of Strongyloides stercoralis infection during immunosuppressive therapy for COVID-19 [1]⁠. As a matter of fact, dexamethasone has clearly shown to reduce mortality for COVID-19 in a randomized clinical trial [2]⁠. More recently, international trials showed a benefit in terms of survival with the use of IL-6 antagonists, such as tocilizumab and sarilumab [3, 4]. Moreover, additional treatment options, such as higher dose of corticosteroids and other immunosuppressive drugs, are being evaluated in clinical trials, used off-label or in the context of compassionate programs [5]⁠⁠. The risk of reactivation of latent infections in COVID-19 patients treated with such medications may be considered limited if compared to that of patients with chronic immune-mediated diseases, since treatment course is usually shorter. However, no specific studies have addressed this point so far.