Diagnosis of latent strongyloidiasis following Corticosteroid Therapy in a Patient with COVID-19 infection

Strongyloidiasis, classified as a neglected tropical disease (NTD), is predominantly prevalent in tropical and subtropical areas, impacting an estimated 100-370 million individuals globally. The northern and southern provinces of Iran are recognized as endemic areas for this disease, characterized by environmental conditions such as optimal temperature and humidity conducive to the survival of the causative agent. Although this disease commonly presents no symptoms, individuals with compromised immune systems or those undergoing corticosteroid treatment face an elevated risk of developing hyperinfection syndrome, a serious complication with potentially fatal outcomes. In the case of immunocompromised patients, especially those receiving corticosteroid therapy, the timely diagnosis of strongyloidiasis is imperative as the infection can lead to life-threatening outcomes. This study reports a case of latent strongyloidiasis diagnosis using a serological method. A 68-year-old woman, originally from Guilan Province, living in Tehran Province, with a history of asthma for over a decade, was hospitalized and received corticosteroid treatment for COVID-19. She exhibited symptoms such as shortness of breath, constipation, skin itching, and abdominal bloating. Upon referral to the Diagnostic Laboratory of Strongyloidiasis at the School of Public Health, Tehran University of Medical Sciences, the patient tested positive for Strongyloides stercoralis using an enzyme-linked immunosorbent assay (ELISA) kit (Novalisa, NovaTec, Germany). The infection was successfully treated with anthelmintic drugs. It is crucial to consider strongyloidiasis in patients with a history of residing in endemic areas or immigration, and testing should be conducted before initiating immunosuppressive therapy. The ELISA method is a rapid and effective diagnostic tool for detecting S. stercoralis in suspected patients, particularly before corticosteroid treatment.