Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
Department of Pharmacy, Hennepin Healthcare, Minneapolis, Minnesota.
Am J Trop Med Hyg. 2023 Jul 17;109(3):650-655. doi: 10.4269/ajtmh.23-0121. Print 2023 Sep 6.
Strongyloides stercoralis is a parasitic roundworm that is present worldwide and can cause lifelong, often asymptomatic, infection. Immunosuppression, particularly by corticosteroids, is a risk factor for hyperinfection syndrome and disseminated strongyloidiasis-severe disease states that can lead to septic shock and death. Our institution implemented a strongyloidiasis screening and empiric ivermectin treatment protocol for inpatients receiving high-dose corticosteroids for severe COVID-19. Among 487 COVID-19 admissions treated with high-dose corticosteroids from June 10, 2020 to March 31, 2021, 61% of those with demographics at risk for Strongyloides exposure were screened for Strongyloides and treated empirically with ivermectin. Adherence to the protocol declined over time during the study period. The empiric ivermectin protocol appeared safe, but more research is needed to determine the effect on hyperinfection and/or disseminated strongyloidiasis risk and mortality rate, as well as to improve institutional adherence to the protocol.
粪类圆线虫是一种寄生性的圆形蠕虫，广泛存在于世界各地，可导致终生、通常无症状的感染。免疫抑制，特别是皮质类固醇的使用，是导致过度感染综合征和播散性粪类圆线虫病的危险因素——严重的疾病状态可导致感染性休克和死亡。我们机构为因严重 COVID-19 而接受大剂量皮质类固醇治疗的住院患者实施了粪类圆线虫病筛查和经验性伊维菌素治疗方案。在 2020 年 6 月 10 日至 2021 年 3 月 31 日期间接受大剂量皮质类固醇治疗的 487 例 COVID-19 住院患者中，有 61%的具有粪类圆线虫暴露风险的患者进行了粪类圆线虫筛查，并接受了经验性伊维菌素治疗。在研究期间，该方案的依从性随时间推移而下降。经验性伊维菌素方案似乎是安全的，但需要进一步研究以确定其对过度感染和/或播散性粪类圆线虫病风险和死亡率的影响，并改善机构对该方案的依从性。
