Study 10 — FAERS Pharmacovigilance: Corticosteroid-Induced Strongyloides Hyperinfection Signal (2016-2022)

Study 10 of the Hidden Infections research series. Evidence tier: STRONG. Strongyloides stercoralis hyperinfection syndrome (SHS) carries no pre-emptive screening protocol in any major prescribing guideline for corticosteroids. This study analyses FDA Adverse Event Reporting System (FAERS) pharmacovigilance data from 2016-2022 to quantify the disproportionality signal for Strongyloides adverse events in corticosteroid recipients using Reporting Odds Ratios (ROR). Key findings: ROR is 14.76 for dexamethasone and 20.63 for prednisone — approximately 2.2x the analogous signal for Pneumocystis jirovecii pneumonia (PCP), which carries its own mandatory prophylaxis protocol. Despite a larger pharmacovigilance signal than PCP, Strongyloides has zero equivalent prophylaxis guidance. This signal underestimates true risk due to extreme underreporting in endemic countries. A companion study (Study 12) demonstrates global-scale validation through the COVID-19 dexamethasone programme. Group C: Pharmacovigilance and surveillance. CC0 public domain. AI-assisted draft pre-print.