Am J Trop Med Hyg. 2021 Mar 15;104(5):1611-1612. doi: 10.4269/ajtmh.20-1085.
COVID-19 can trigger a systemic inflammatory response that in some cases leads to severe lung involvement, multisystem dysfunction, and death. Dexamethasone therapy, because of its potent anti-inflammatory effects, has been proposed for the management of hospitalized patients with severe COVID-19. The subject of this article is to discuss potential strategies to tackle Strongyloides hyperinfection in hospitalized patients with COVID-19 receiving dexamethasone therapy in low- and middle-income countries. In this context, dexamethasone treatment has been found to be generally safe. However, its use in people coinfected with undetected Strongyloides stercoralis increases the risk for Strongyloides hyperinfection/dissemination a potentially fatal complication. Infection caused by S. stercoralis may remain asymptomatic or with mild symptoms in humans for several years. Early detection and specific treatment prevent a fatal evolution of this complication, but the challenge is to screen before corticosteroid therapy. In some cases, presumptive treatment may be justified. Ivermectin is the gold standard for treatment.
COVID-19 可引发全身性炎症反应，某些情况下可导致严重肺部受累、多系统功能障碍和死亡。地塞米松因具有强大的抗炎作用，被提议用于治疗住院的重症 COVID-19 患者。本文的主题是讨论在中低收入国家，针对接受地塞米松治疗的住院 COVID-19 患者中潜在的强力钩虫感染处理策略。在这种情况下，地塞米松治疗通常是安全的。然而，在未检测到的 Strongyloides stercoralis 合并感染的人群中使用地塞米松会增加强力钩虫感染/传播的风险，这是一种潜在致命的并发症。人类感染 S. stercoralis 可能会在数年内无症状或出现轻微症状。早期发现和特异性治疗可预防这种并发症的致命进展，但挑战在于在皮质类固醇治疗之前进行筛查。在某些情况下，可进行经验性治疗。伊维菌素是治疗的金标准。
