Salvage treatment of disseminated strongyloidiasis in an immunocompromised patient: therapy success with subcutaneous ivermectin

Moura, Edmilson Bastos de; Maia, Marcelo de Oliveira; Ghazi, Monalisa; Amorim, Fábio Ferreira; Pinhati, Henrique Marconi Sampaio

doi:10.1016/j.bjid.2012.08.008

Cited by 12 publications

(8 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ivermectin and benzimidazoles (thiabendazole, mebendazole and albendazole) are becoming the drugs of choice for strongyloides infection in many countries [ 27, 28 ]. Ivermectin inhibits neurotransmission, while benzimidazoles disrupt energy production in the parasites with optimal anthelmintic activities [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Khadka

Thapaliya

et al. 2018

JMM Case Reports

View full text Add to dashboard Cite

Introduction Strongyloidiasis is a neglected tropical disease with global prevalence. Under some cases of immune suppression (especially with corticosteroid administration), the nematode involved disseminates, leading to an amplified, possibly lethal hyper-infection syndrome.Case presentation A 56-year-old Nepalese man presenting with chief complaints of nausea, vomiting, joint pain and abdominal cramps was admitted to Sumeru Hospital. His past history revealed: chronic obstructive pulmonary disease (COPD), systemic hypertension and previously treated pulmonary tuberculosis. The patient had been treated with oral prednisolone (60 mg gl−1) for 8 days due to a presumed exacerbation of his COPD. Sequentially, he developed haemoptysis, chest tightness, frequent wheezing and worsening cough. Bronchoscopy showed severe diffuse alveolar haemorrhage; microbiological examination of broncho-alveolar lavage (BAL) was recommended. Examination of an acid fast bacilli stain preparation of BAL revealed filariform larvae of Strongyloides. Stool specimen examination revealed larvae of Strongyloides. The physical condition of the patient began to deteriorate; a few days after admission, vancomycin-sensitive Enterococcus faecium was isolated from a blood sample. He was treated with ivermectin and albendazole for strongyloides and linezolid plus vancomycin for E. faecium. However, the patient failed to recover from the illness and died.Conclusion The findings of our study suggest that corticosteroid administration in strongyloidiasis can lead to the development of fatal strongyloides hyper-infection syndrome. Hence our experience suggests the need for early diagnosis of strongyloidiasis to avoid such an outcome. A deterioration of the patient's condition after the initiation of corticosteroid therapy in endemic areas should raise the possibility of strongyloidiasis.

show abstract

Section: Discussionmentioning

confidence: 99%

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Khadka

Thapaliya

et al. 2018

JMM Case Reports

View full text Add to dashboard Cite

show abstract

“…5,8 Case reports clearly demonstrate that in patients with hyperinfection and ileus, subcutaneous IVM achieves higher serum concentrations than nasogastric or rectal administration. [9][10][11][12] However, appropriate target concentrations for IVM and ABZ have not been established. A wide variation of serum IVM concentrations have been described.…”

Section: Discussionmentioning

confidence: 99%

“…Parasitologic cure rates have not yet been established for the treatment of disseminated strongyloidiasis. The time interval between initiation of IVM therapy and parasitologic clearance shows significant variability, ranging between 6 and 37 days 11,15,16 In one study, mean duration of larval shedding For IVM, plasma concentrations were determined using HPLC with fluorescence detection as previously described. 1 Albendazole, ABZ-OX, and ABZ-ON were determined using a validated liquid chromatography-mass spectrometric (LC-MS/MS) method.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

Boodman

Chhonker

Murry

et al. 2018

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Disseminated strongyloidiasis is often fatal, despite treatment with oral albendazole and parenteral ivermectin (IVM). Here, we report elevated plasma IVM and albendazole sulfoxide concentrations in the context of extracorporeal membrane oxygenation and continuous renal replacement therapy in a patient with disseminated strongyloidiasis treated with subcutaneous IVM and nasogastric albenzadole. Despite elevated drug plasma concentrations, live filariform larvae were detected in endotracheal aspirates after 2 weeks of treatment.

show abstract

“…These include per rectal and parenteral formulations (Grein et al 2010). The parenteral formulation is a veterinary formulation of ivermectin and should be reserved for extreme situations with no other options for clearing the Strongyloides infection (Marty et al 2005; Salluh et al 2005; Turner et al 2005; Suputtamongkol et al 2008; Lichtenberger et al 2009; Marcos et al 2011; Moura et al 2012; Donadello et al 2013; Barrett et al 2016). …”

Section: Treatmentmentioning

confidence: 99%

Human infection withStrongyloides stercoralisand other related Strongyloides species

2016

View full text Add to dashboard Cite

SUMMARY The majority of the 30–100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics – including new immunoassays and molecular tests – will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.

show abstract

Salvage treatment of disseminated strongyloidiasis in an immunocompromised patient: therapy success with subcutaneous ivermectin

Cited by 12 publications

References 11 publications

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

Human infection withStrongyloides stercoralisand other related Strongyloides species

Contact Info

Product

Resources

About