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COVID-19 and DexamethasoneA Potential Strategy to Avoid Steroid-Related Strongyloides Hyperinfection

Educational Objective
To understand how to prescribe dexamethasone while avoiding hyperinfection
1 Credit CME

A widely publicized press release and subsequent preliminary report of the RECOVERY trial, a randomized study conducted in the UK, noted a survival benefit with the use of dexamethasone in hospitalized patients with coronavirus disease 2019 (COVID-19).1 The use of dexamethasone for management of COVID-19 has already increased, particularly given the recent National Institutes of Health COVID-19 Treatment Panel guidelines that recommend its use.2

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: William M. Stauffer, MD, MSPH, Department of Medicine, University of Minnesota, 420 Delaware St SE, MMC 250, Minneapolis, MN 55455 (stauf005@umn.edu).

Published Online: July 30, 2020. doi:10.1001/jama.2020.13170

Conflict of Interest Disclosures: Dr Stauffer reported serving as the lead medical advisor of the Immigrant, Refugee, and Migrant Health Branch at the CDC, where he has been an author on the refugee predeparture and postarrival parasitic screening and presumptive treatment guidelines, and has received royalties from UpToDate. Dr Walker reported receiving royalties from Elsevier and UpToDate outside the submitted work. No other disclosures were reported.

Disclaimer: The views expressed herein are the opinions of the authors and do not represent the position of the CDC, which did not participate in the development of this article, or any organization with which the authors are affiliated.

References
1.
The RECOVERY Collaborative Group.  Dexamethasone in hospitalized patients with Covid-19—preliminary report.   N Engl J Med. Published online July 17, 2020. doi:10.1056/NEJMoa2021436PubMedGoogle Scholar
2.
Corticosteroids (including dexamethasone). NIH website. Updated July 17, 2020. Accessed July 22, 2020. https://www.covid19treatmentguidelines.nih.gov/dexamethasone/
3.
Krolewiecki  A , Nutman  TB .  Strongyloidiasis: a neglected tropical disease.   Infect Dis Clin North Am. 2019;33(1):135-151. doi:10.1016/j.idc.2018.10.006PubMedGoogle ScholarCrossref
4.
Requena-Méndez  A , Buonfrate  D , Gomez-Junyent  J ,  et al.  Evidence-based guidelines for screening and management of strongloidiasis in non-endemic countries.   Am J Trop Med Hyg. 2017;97(3):645-652.PubMedGoogle ScholarCrossref
5.
Boggild  AK , Libman  M , Greenaway  C ,  et al.  CATMAT statement on disseminated strongyloidiasis: prevention, assessment and management guidelines.   Can Commun Dis Rep. 2016;42(1):12-19. doi:10.14745/ccdr.v42i01a03PubMedGoogle ScholarCrossref
6.
Puthiyakunnon  S , Boddu  S , Li  Y ,  et al.  Strongyloidiasis–an insight into its global prevalence and management.   PLoS Negl Trop Dis. 2014;8(8):e3018. doi:10.1371/journal.pntd.0003018PubMedGoogle Scholar
7.
Olsen  A , van Lieshout  L , Marti  H ,  et al.  Strongyloidiasis—the most neglected of the neglected tropical diseases?   Trans R Soc Trop Med Hyg. 2009;103(10):967-972.PubMedGoogle ScholarCrossref
8.
Asundi  A , Beliavsky  A , Liu  XJ ,  et al.  Prevalence of strongyloidiasis and schistosomiasis among migrants.   Lancet Glob Health. 2019;7(2):e236-e248. PubMedGoogle ScholarCrossref
9.
Presumptive treatment and screening for strongyloidiasis, infections caused by other soil-transmitted helminths, and schistosomiasis among newly arrived refugees. CDC website. Accessed July 5, 2020. https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites-domestic.html
10.
Geri  G , Rabbat  A , Mayaux  J ,  et al.  Strongyloides stercoralis hyperinfection syndrome.   Infection. 2015;43(6):691-698.PubMedGoogle ScholarCrossref
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