Strongyloidiasis Outside Endemic Areas: Long-term Parasitological and Clinical Follow-up After Ivermectin Treatment

Abstract

These results suggest that the parasitological cure is unlikely. Strongyloidiasis must be considered a chronic infection and ivermectin administration schedules should be reevaluated.

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

“…Similarly, in the report by Abanyie et al, fourteen recipients of organs from Strongyloides seropositive donors received prophylaxis after transplantation, and no recipients developed strongyloidiasis . Thus, although we do not routinely assess for changes in eosinophil counts or follow‐up Strongyloides serology to document serological conversion to negative as a surrogate marker of response to ivermectin therapy (reported rates of reversion to negative vary according to serological test and range from 40% to 73%), ivermectin prophylaxis administered prior to transplant or early post‐transplant (ie, prior to hospital discharge from transplant hospitalization) seems to be highly effective at preventing recipient‐derived and donor‐derived Strongyloides infection post‐transplant.…”

“…Thus, there is no role for a “test of cure” in patients treated for chronic Strongyloides . In addition, although recent data indicate that S stercoralis DNA can be detected in stool by PCR following ivermectin treatment, to this date, disease has not been reported in treated seropositive recipients or those recipients of organs from donors with proven or suspected evidence of strongyloidiasis who have been prophylactically treated with ivermectin . Thus, even with contemporary molecular methods, there does not seem to be any role for laboratory test of cure in latent Strongyloides infection.…”

“…In transplant patients with a compatible clinical syndrome, appropriate samples (eg, stool and respiratory samples) should be obtained for direct examination for Strongyloides larvae. Real‐time polymerase chain reaction (RT‐PCR) for detection of S stercoralis in stool is a new diagnostic tool that might facilitate early diagnosis but test is not widely available, and one concern is that nucleic acid testing might detect non‐viable larvae.…”

“…Thus, there is no role for a "test of cure" in patients treated for chronic Strongyloides. In addition, although recent data indicate that S stercoralis DNA can be detected in stool by PCR following ivermectin treatment,20 to this date, disease has not been reported in treated seropositive recipients or those recipients of organs from donors with proven or suspected evidence of strongyloidiasis who have been prophylactically treated with ivermectin 8,10. Thus, even with contemporary molecular methods, there does not seem to be any role for laboratory test of cure in latent Strongyloides infection.As illustrated by this case, donor-derived infections do not always present in the early (<30 days) post-transplant period23 ; thus, transplant patients should be educated about the risk of donor-derived transmission, and clinicians should always consider the possibility of donor-derived events in SOT recipients admitted with febrile illness or unexplained clinical syndromes even when presenting beyond the first month post-transplant.…”

Decrease in eosinophilia as a marker of response to therapy in solid organ transplant candidates with Strongyloides infection: A single‐center experience

“…6,7 Clinical experience with Strongyloides PCR is limited and molecular methods are not widely available; even more, PCR test might remain positive after ivermectin therapy. 8 Data in non-SOT patients indicate that eosinophilia, when present, can be followed after anthelmintic treatment as marker for response to therapy. [6][7][8][9][10] In an effort to address the paucity of biomarkers to assess treatment response in SOT population, we assessed the trend in the In bold: patient without improvement of eosinophilia.…”