Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment

Choksi, Tatvam; Madison, Gul; Dar, Tawseef; Asif, Mohammed; Fleming, Kevin C.; Clarke, Leon; Danilewitz, Mervyn; Hennawy, Randa

doi:10.4269/ajtmh.16-0259

Cited by 11 publications

(7 citation statements)

References 37 publications

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“…In patients co-infected with HTLV-1 and S. stercoralis both parasite antigen-specific IL-5 responses and eosinophil levels were significantly decreased, suggesting an additional means by which the virus infection may impede immunity to helminths. However, rare incidences of acute respiratory distress syndrome have been encountered in HTLV-1-infected patients following treatment with antihelminthics ( 95 ). The mechanisms responsible for the development of this pathology are unknown, but it is plausible that acute immune reactions to the intrapulmonary destruction of the large parasite burden following antihelminthic treatment may play a role in triggering this response ( 95 ).…”

Section: Effects On Viral Infectionsmentioning

confidence: 99%

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

Mabbott

2018

Front. Immunol.

107

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Parasites have evolved a wide range of mechanisms that they use to evade or manipulate the host's immune response and establish infection. The majority of the in vivo studies that have investigated these host-parasite interactions have been undertaken in experimental animals, especially rodents, which were housed and maintained to a high microbiological status. However, in the field situation it is increasingly apparent that pathogen co-infections within the same host are a common occurrence. For example, chronic infection with pathogens including malarial parasites, soil-transmitted helminths, Mycobacterium tuberculosis and viruses such as HIV may affect a third of the human population of some developing countries. Increasing evidence shows that co-infection with these pathogens may alter susceptibility to other important pathogens, and/or influence vaccine efficacy through their effects on host immune responsiveness. Co-infection with certain pathogens may also hinder accurate disease diagnosis. This review summarizes our current understanding of how the host's immune response to infection with different types of parasites can influence susceptibility to infection with other pathogenic microorganisms. A greater understanding of how infectious disease susceptibility and pathogenesis can be influenced by parasite co-infections will enhance disease diagnosis and the design of novel vaccines or therapeutics to more effectively control the spread of infectious diseases.

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Section: Effects On Viral Infectionsmentioning

confidence: 99%

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

Mabbott

2018

Front. Immunol.

107

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“…Our systematic search of the literature for non-neurological adverse events found 10 cases where ivermectin was associated with cutaneous reactions [11][12][13][14][15], nephropathy [16], psychiatric disorders [17,18], hepatic disorders [19,20] and multiorgan dysfunction syndrome [21]. Clinical trials and observational studies have reported common adverse events such as headache, pruritus, muscle pain, cough, dyspnea, nausea, vomiting, diarrhea, blurred vision, postural hypotension and confusion and more anecdotal effects such as serious skin reactions and edematous swelling [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Serious adverse reactions associated with ivermectin: A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World

et al. 2021

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Background Ivermectin is known to cause severe encephalopathies in subjects infected with loiasis, an endemic parasite in Sub-Saharan Africa (SSA). In addition, case reports have described ivermectin-related serious adverse drug reactions (sADRs) such as toxidermias, hepatic and renal disorders. The aim of this study was to identify suspected sADRs reported after ivermectin administration in VigiBase, the World Health Organization’s global individual case safety reports database and analyze their frequency relative to the frequency of these events after other antinematodal drugs reported in SSA and other areas of the world (ROW). Methods All antinematodal-related sADRs were extracted from VigiBase. Disproportionality analyses were conducted to investigate nervous, cutaneous, psychiatric, respiratory, renal, hepatic and cardiac suspected sADRs reported after ivermectin and benzimidazole drug administration across the world, in SSA and RoW. Principal findings 2041 post-ivermectin or post-benzimidazole suspected sADRs were identified including 667 after ivermectin exposure (208 in SSA and 459 in the RoW). We found an increased reporting for toxidermias, encephalopathies, confusional disorders after ivermectin compared to benzimidazole drug administration. Encephalopathies were not only reported from SSA but also from the RoW (adjusted reporting odds ratios [aROR] 6.30, 95% confidence interval: 2.68–14.8), highlighting the fact these types of sADR occur outside loiasis endemic regions. Conclusion We described for the first time suspected sADRs associated with ivermectin exposure according to geographical origin. While our results do not put in question ivermectin’s excellent safety profile, they show that as for all drugs, appropriate pharmacovigilance for adverse reactions is indicated.

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“…Single-dose ivermectin has recently been evaluated successfully for the treatment of nondisseminated strongyloidiasis in a randomised controlled superiority trial [ 9 ]. Nevertheless, the medical community should be aware that deworming in hyperinfected patients is both essential and at risk of worsening the patient's condition as has been already reported [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal Multiorgan Failure Syndrome in a Strongyloides-HTLV-1 Coinfected Patient, after Treatment with Ivermectin

Guérin

Poirier

Nervo³

et al. 2021

Case Reports in Critical Care

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Because of its characteristic features of autoinfection, the parasitic nematode Strongyloides stercoralis can infect patients for years. An acceleration of its autoinfective cycle can be triggered by human T-lymphotropic virus-1 (HTLV-1) infection, mainly by the deviation of the protective Th2- to Th1-type immune response and can lead to severe disease by dissemination of Strongyloides stercoralis larvae carrying intestinal bacteria to multiple organs. Meningitis caused by enteric Gram-negative bacteria is a potentially fatal complication of disseminated strongyloidiasis. Herein, we present the case of a Strongyloides-HTLV-1 coinfected patient, admitted for E. coli meningitis. One day after initiation of ivermectin, the patient developed significant S. stercoralis dissemination, complicated by multiorgan failure syndrome, and died from neurological failure. While the initial clinical scenario of our case has already been well described in the literature, its course after antihelminthic treatment initiation remains unclear and needs to be discussed.

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Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment

Cited by 11 publications

References 37 publications

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

The Influence of Parasite Infections on Host Immunity to Co-infection With Other Pathogens

Serious adverse reactions associated with ivermectin: A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World

Fatal Multiorgan Failure Syndrome in a Strongyloides-HTLV-1 Coinfected Patient, after Treatment with Ivermectin

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