The Corticosteroid Immune-Brake Problem: A Class-Level Synthesis of Strongyloides, Aspergillus, and Mucor Reactivation Risk

Background: Corticosteroids suppress multiple distinct components of host innate and adaptive immunity. Three taxonomically unrelated organisms — Strongyloides stercoralis (nematode), Aspergillus fumigatus (ascomycete), and Mucor/Rhizopus species (zygomycete) — exploit this suppression to cause life-threatening disease in corticosteroid recipients. Each carries a case-fatality rate of 30–50% or higher in treated cases. Each is managed under a separate specialist framework with separate guidelines. No unified pre-corticosteroid co-infection risk protocol covers all three simultaneously. Argument: This is a class-level drug safety problem that is being managed as three separate specialty problems. The common variable is the drug, not the organism. Clinical organisation by organism taxonomy has prevented recognition of corticosteroids as a shared pathogenic trigger, produced a 52–58 year evidence-to-guideline lag for Strongyloides (Study 1 ([10.5281/zenodo.20402597](https://doi.org/10.5281/zenodo.20402597))), and left no guideline body responsible for the combined reactivation risk. Proposal: A unified pre-corticosteroid co-infection screen — Strongyloides IgG serology, galactomannan...