An approach to review SARS-CoV-2 and Strongyloides stercoralis coinfections

In a recent article posted to the medRxiv* preprint server, researchers present the protocol for their systematic review on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Strongyloides stercoralis coinfections.

Study: Coinfection with Strongyloides and SARS-CoV-2: protocol for a systematic review. Image Credit: Gorodenkoff / Shutterstock.com

Background

Strongyloidiasis, an infection caused by soil transmission of the Strongyloides stercoralis roundworm, occurs in endemic and less-endemic regions throughout the world. Strongyloides stercoralis can replicate and persist in their hosts for several decades with no/minimal symptoms or result in fatal hyperinfection syndrome (HS) when immunocompromised individuals are infected.

The clinical presentation of strongyloidiasis includes non-symptomatic gut infections, acute dermatological infections with Loeffler’s syndrome, chronic gut diseases with anemia, diarrhea, malabsorption, and elevated eosinophil counts, a disseminated form of strongyloidiasis (DS), and HS.

HS is most commonly triggered by corticosteroids, anti-inflammatory medications routinely prescribed to patients with coronavirus disease 2019 (COVID-19). Thus, there are increased risks of DS and HS among individuals with Strongyloides stercoralis and SARS-CoV-2 coinfections.

Further research on the connections between these two conditions could aid in the development of potential therapeutic interventions, as well as improve the understanding of potential outcomes of strongyloidiasis in light of the COVID-19 pandemic.

About the protocol

Researchers describe the protocol for their systematic review of concomitant COVID-19 and strongyloidiasis to assess the pathological outcomes and potential therapies. Current challenges in DS and HS management in the COVID-19 pandemic and existing gaps in research that require attention were also addressed.

For the systematic review, a literature search would be performed on databases such as the World Health Organization (WHO) COVID-19 and LitCOVID databases using search terms such as ‘Strongyloidiasis,’ ‘Strongyloides,’ ‘Anguillulosis,’ and ‘Anguillulose’ for relevant records published in any language. In addition, the references of relevant records would be screened to find additional studies.

Studies comprising individuals with strongyloidiasis and SARS-CoV-2 infections, irrespective of individual age, sex, and place of residence, should be included. Possible study designs could consist of case reports and case series, interventional-type studies, retrospective or prospective observational-type studies, and systematic reviews. Conference presentation abstracts may also be included if the study authors have not published full-text articles of the studies.

Data on the study authors, year of publication, the country where the study has been published, study design, and patients’ data, including age, sex, nationality, immune status, comorbid conditions, medications, and clinical presentation of the diseases, should also be included.

In addition, the duration between the onset of COVID-19 and strongyloidiasis symptoms, the duration between strongyloidiasis and COVID-19 diagnoses, post-mortem records, therapeutic interventions, the severity of SARS-CoV-2 infections, coinfection evolution and outcomes, and predicted underlying biological pathways of the clinical manifestations of Strongyloides stercoralis infections should also be extracted.

Data should be extracted by one study reviewer and assessed independently by another. Based on the included records, one reviewer would evaluate the association between corticosteroid use and Strongyloides stercoralis infections. Conversely, the other reviewer, ideally experienced in strongyloidiasis diagnosis and management, would independently verify the causality. Disagreements would be resolved by consensus or a third reviewer if needed.

The WHO-Uppsala monitoring center (WHO-UMC) assessment system would be adapted for causality assessments to determine whether corticosteroid administration to SARS-CoV-2-positive individuals contributes to the clinical presentations of acute Strongyloides stercoralis infections. Causality would be categorized as certain, likely/probable, probable, not likely, or unclear for the association between corticosteroid use and Strongyloides stercoralis infections.

Individual-level results would be documented in the systematic review wherever possible. Furthermore, a meta-analysis would be performed if considered appropriate.

The study findings would be presented under three subcategories, including a study description, data extraction, and quality assessments. The evidence would be summarized with a conclusion based on the quality of included studies. The outcomes would comprise Strongyloides stercoralis reactivation in the COVID-19 scenario.

A narrative-type summary of clinical, paraclinical, and epidemiological data would be provided. Outcomes would also be documented and inclusive of quantitative predictions wherever relevant and feasible.

When possible, the appropriate datasets could be integrated for a meta-analysis. The team would also document policy and research implications based on the review findings.

Based on the aforementioned protocol, a systematic review of SARS-CoV-2 and Strongyloides stercoralis coinfections would be conducted.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behaviour, or treated as established information.

Written by

Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.