Subcutaneous Ivermectin as a Safe Salvage Therapy in Strongyloides Stercoralis Hyperinfection Syndrome: A Case Report

Pacanowski, Jérôme; Santos, Marie Dos; Roux, A.; Maignan, Christine Le; Guillot, Jacques; Lavarde, V.; Cornet, Muriel

doi:10.4269/ajtmh.2005.73.122

Cited by 64 publications

(38 citation statements)

References 14 publications

(20 reference statements)

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“…Treatment options include ivermectin, albendazole, and thiabendazole 2,7,18 . Ivermectin is generally considered the treatment of choice because of higher clearance rate and a favorable side-effect profile 7,10 .…”

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

Tsai

et al. 2011

International Journal of Gerontology

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s u m m a r yStrongyloidiasis is endemic in tropic and subtropic areas, but is currently seldom encountered in developed area like Taiwan. We present an elder man with acute respiratory distress syndrome complicating Strongyloides stercoralis hyperinfection. There was no significant clue initially for diagnosing this patient as having S. stercoralis hyperinfection. Neither peripheral eosinophilia nor significant hemoptysis was noted. Bronchoscopy played a critical role to define the unexpected cause of his progressive pulmonary infiltrates. The correct diagnosis was soon made by recognition of the worm in bronchioloalveolar lavage cytology, and specific treatment was initiated promptly. For a septic patient with progressive pulmonary infiltrates, bronchoscopic studies including cytology may be necessary for defining the cause. Hyperinfection strongyloidiasis should be considered as a cause of acute respiratory distress syndrome in immunocompromised patient, especially with the presence of chronic gastrointestinal symptoms.

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Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

Tsai

et al. 2011

International Journal of Gerontology

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“…3 SC administration is the most frequent non-oral route of ivermectin delivery and has been reported in several case reports and case series. [4][5][6][7][8][9][10][11][12] Although there are many cases of patient recovery, several clinical failures are reported as well. 9,11,12 Several studies that measured plasma concentrations of subcutaneously administered ivermectin 5,8,9,11,12 have usually demonstrated levels within a range well tolerated by healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

Failure of Ivermectin per Rectum to Achieve Clinically Meaningful Serum Levels in Two Cases of Strongyloides Hyperinfection

Bogoch¹,

Khan²,

Abrams³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. Two cases of Strongyloides hyperinfection are presented. Ivermectin was initially administered orally and per rectum pending the availability of subcutaneous (SC) preparations. In neither case did rectal suppositories of ivermectin achieve clinically meaningful serum values. Clinicians should use SC preparations of ivermectin as early as possible in Strongyloides hyperinfection and dissemination. CASE 1A 38-year-old Nigerian-born female with no prior medical history presented with worsening nausea and vomiting over a 6-week period. One year prior admission she had traveled to Nigeria for 1 month. Two months before admission she was referred to a gastroenterologist for dyspepsia and underwent upper endoscopy with a small bowel biopsy. At the time of her presentation to hospital, endoscopic biopsy results showed filariform larvae of Strongyloides stercoralis. On admission she was ill appearing, afebrile, with a blood pressure of 90/ 50 mmHg, heart rate of 115 beats/min, and normal oxygen saturations. Her examination was unremarkable apart from a tender epigastrium and diminished bowel sounds.Blood examination revealed a normal complete blood count, creatinine, and liver function tests. Computed tomography (CT) of her abdomen with contrast demonstrated a thickened proximal small bowel wall and evidence of ileus. Strongyloides hyperinfection syndrome was suspected, and she was empirically treated with crystalloid resuscitation and albendazole (400 mg PO BID) while an urgent request for ivermectin was made to Health Canada (ivermectin is a special access drug in Canada available only with the authorization of the Health Protection Branch). In addition, intravenous ceftriaxone and metronidazole were administered for presumed gram-negative sepsis. The patient was unable to tolerate oral albendazole because of intractable nausea and vomiting, so albendazole was administered via nasogastric (NG) tube although there was concern regarding poor absorption given her ileus and persistent vomiting. Pending the availability of subcutaneous (SC) ivermectin, we had a compounding pharmacy prepare oral ivermectin into rectal suppositories; we administered these in the evening on her first and second hospital day (200 μg/kg, totaling 15 mg per rectum (PR). Her persistent ileus prompted the General Surgery service to perform an urgent laparotomy on her second hospital day. She was found to have a dilated proximal small bowel, what appeared to be a fecal bezoar as a result of the ileus that was milked distally. She required norepinephrine for blood pressure control during the operation and for 6 hours immediately after. She was extubated shortly after her laparotomy and was able to tolerate oral medications the following day at which point she was given oral ivermectin. Table 1 shows her medication schedule and microbiology results during and after her hospital stay. Serum ivermectin levels were measured on hospital day 2, 3, and 8 as per the protocol described previously in a study. 1 PR ivermectin did not achieve clinicall...

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“…Recent reports of several cases of fatal disseminated strongyloidiasis in developed countries highlight the problem of a disease which is underestimated due both to the low level of clinical suspicion and to the insensitivity of direct diagnostic tools (4,6,11,12,24,34,35,44,45,49,51,59).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an Indirect Immunofluorescence Assay for Strongyloidiasis as a Tool for Diagnosis and Follow-Up

Boscolo

Gobbo

Mantovani

et al. 2007

Clin Vaccine Immunol

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The diagnostic accuracy of an indirect immunofluorescence antibody test (IFAT) for Strongyloides stercoralis at different serum antibody titers was evaluated. To assess diagnostic sensitivity, sera from 156 patients with known strongyloidiasis were collected. Negative control sera were obtained from a composite group of 427 subjects (blood donors and hospitalized patients). With an area under the receiver-operating characteristic plot of 0.98, the IFAT showed a high level of diagnostic accuracy for strongyloidiasis. An antibody titer of >1:20, with 97% sensitivity and 98% specificity, was identified as the diagnostic threshold with the best overall performance. Cross-reactions were evaluated with 41 additional samples from patients with other known helminth infections, and the IFAT detected low-titer positivity in only one subject with filariasis. A positive IFAT result at an antibody dilution of >1:80 was virtually 100% specific, with 71% sensitivity. To test the usefulness of the IFAT as a monitoring tool, the changes in specific-antibody titers after treatment in a group of 155 patients were evaluated. Seroreversion or a decrease in antibody titer of twofold or more was observed in 60% of the patients. Response to treatment was directly correlated to the initial antibody titer, and a baseline titer of >1:80 was identified as the best predictor of response. In conclusion, a positive IFAT result at an antibody dilution of >1:20 is the optimal cutoff for screening. A titer of >1:80, with virtually no false-positive result, is a reliable cutoff for a serological assessment of treatment efficacy and for inclusion in clinical trials.

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Subcutaneous Ivermectin as a Safe Salvage Therapy in Strongyloides Stercoralis Hyperinfection Syndrome: A Case Report

Cited by 64 publications

References 14 publications

Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

Failure of Ivermectin per Rectum to Achieve Clinically Meaningful Serum Levels in Two Cases of Strongyloides Hyperinfection

Evaluation of an Indirect Immunofluorescence Assay for Strongyloidiasis as a Tool for Diagnosis and Follow-Up

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