Serological Evidence of Strongyloidiasis in COVID-19 Hospitalized Patients in Northern Iran during the Pandemic: Prevalence and Risk Factors

Strongyloidiasis, a parasitic infection caused by the intestinal nematode Strongyloides stercoralis , remains a significant public health concern in tropical and subtropical regions. This helminthic infection poses particular risks for immunocompromised individuals, potentially progressing to life-threatening hyperinfection syndrome and disseminated disease. In Iran, endemic foci of S. stercoralis have been well-documented in both northern and southern coastal provinces. The current COVID-19 pandemic has introduced new clinical challenges, as immunosuppressive therapies commonly employed in COVID-19 management may predispose patients to severe parasitic complications. This descriptive cross-sectional study aimed to determine both the seroprevalence of S. stercoralis infection and associated risk factors among COVID-19 patients of Guilan province in northern Iran during 2022. A total of 208 serum samples were collected from patients with COVID-19 referred to Razi Hospital in Rasht City, Guilan province. Demographic data, such as sex, age, job, residential area, and educational level, were recorded through interviews. The presence of the anti- S. stercoralis IgG antibody was detected by S. stercoralis IgG ELISA kit. The seropositive rate of strongyloidiasis was 19.7% of all the studied subjects. The seropositivity rate for strongyloidiasis was 19.7% among the studied subjects. A significant difference ( P  = 0.039) was observed between genders, with 25.2% of males and 13.9% of females testing seropositive. The prevalence was significantly higher ( P  = 0.014) among farmers and workers compared to other occupational groups. Additionally, illiterate individuals had a significantly higher infection rate ( P  = 0.007) than those with formal education. This study highlights a high prevalence of strongyloidiasis among COVID-19 patients in northern Iran. Therefore, screening for Strongyloides infection using serologic methods, particularly in endemic regions should be considered before initiating immunosuppressive therapy in COVID-19 patients. Future epidemiological research should systematically evaluate individual risk factors to facilitate targeted intervention strategies.