CONNECTING THE DOTS: DIABETES AS A RISK FACTOR FOR SEVERE STRONGYLOIDIASIS.

Background: Severe strongyloidiasis caused by the parasite Strongyloides stercoralis can manifest in two distinct forms: Strongyloides hyperinfection syndrome (SHS) and disseminated strongyloidiasis. Both can be the result of multiple risk factors with immunosuppression as the underlying theme: usage of immunosuppressive treatments (drugs, irradiation), organ or bone marrow transplantation, coinfection with HTLV-1 or HIV, presence of IRIS, hematologic malignancies, hypogammaglobulinemia, malnutrition or alcoholism. While severe strongyloidiasis has been described in immunocompetent patients with diabetes mellitus, it is still unclear if diabetes can be considered a relevant risk factor for the infection. Objective: The aim of this comprehensive review is to assess whether diabetes alone can be regarded as a risk factor for the occurrence of severe strongyloidiasis. Material and methods: A search of the existing literature was conducted in three different databases (PubMed, Web of Science, Scopus) by using two separate search algorithms adapted for each one of them: (strongyloides OR strongyloidiasis) AND diabetes AND (hyperinfection OR disseminated strongyloidiasis); (strongyloides OR strongyloidiasis) AND immunocompetent. The searches were performed on the 27th of February 2024 and yielded a total number of 265 results. Case reports and case report series were selected to further apply the inclusion criteria: coexistence of diabetes mellitus and severe strongyloidiasis without any other risk factor associated with the latter being present. A total of 13 cases written in English were included in the final analysis. Results : From the total of 13 patients that met the inclusion criteria, 11 (84.62%) were male and 2 (15.38%) were female. The median age for these patients was 61 years (range 31-82 years). The cases mainly originated in Asia (n = 6, 46.15%) with only one case reported in Europe (n = 1, 7.69%) and one in Australia (n = 1, 7.69%). The rest (n = 5, 38.46%) had northern American origin. Most included cases described SHS (n = 9, 69.23%) and only 4 patients (30.77%) presented with eosinophilia. An increased mortality rate (n = 6, 46.15%) was observed, the cause being failure in diagnosing S. stercoralis infection, a delayed diagnosis, or major complications despite starting appropriate treatment. A total of 9 patients (69.23%) were treated with ivermectin, the first-line therapy for strongyloidiasis. Conclusions: Based on our findings, we cannot exclude diabetes as a risk factor in the occurrence of severe strongyloidiasis. However, due to limited data, future research is required to further reach a clearer conclusion. [ABSTRACT FROM AUTHOR]