Subcutaneous ivermectin use in the treatment of severeStrongyloides stercoralisinfection: two case reports and a discussion of the literature: Table 1.

Abstract

Despite the limited published experience of parenteral ivermectin use, there is evidence that it may be a safe and effective treatment for severe strongyloidiasis. However, more data are needed to guide dosing schedules and monitoring for toxicity.

Strongyloides Stercoralis Hyperinfection Syndrome: An Uncommon Mimicker

“…No licensed parenteral anthelmintic drugs exist in humans. Very few publications in the literature have reported successful treatment of patients with unlabeled parenteral preparations of ivermectin [2,3]. We report a case of a patient who presented with a malabsorption syndrome due to severe intestinal strongyloides.…”

“…Duodenal aspiration and biopsy has been shown to detect SS in 70% of cases [1,2]. Examination of cerebrospinal, pleural, ascites and bronchoalveolar lavage specimens as well as skin and GI tract biopsies have also been used to demonstrate SS larvae in disseminated infection [1, 4,13].…”

“…There have been reports of cure with daily oral or subcutaneous ivermectin (with or without oral albendazole adjunct therapy) [2,3]. Intravenous and rectal enemas preparations seem less successful [2][3][4]. It has been suggested that the treatment duration should be titrated upon clinical status of the patient.…”

“…Strongyloides hyperinfection syndrome (SHS) is a rare presentation characterized by a catastrophic infestation of larvae mostly in the lungs and gastrointestinal (GI) tract [1]. As ileus, intestinal obstruction and malabsorption syndrome are possible complications, enteric absorption of drugs can be impaired [2,3]. No licensed parenteral anthelmintic drugs exist in humans.…”

Estrongiloidosis pulmonar

“…En casos de hiperinfección o diseminación, la ivermectina se dosifica 200 µg/kg/día vía oral hasta que el examen en deposiciones o en esputo permanezca negativo por dos semanas 19,25 , recomendación que fue aplicada en el manejo médico de la paciente. Por otro lado, se ha descrito la aplicación de ivermectina subcutánea en pacientes con estrongiloidosis grave, con resultados exitosos 29 . Finalmente, el pronóstico de esta enfermedad varía de acuerdo a la presentación de la infección, estimándose una letalidad de 15% en la hiperinfección 30 y aumentando significativamente a 85-100% en la estrongiloidosis diseminada…”