Hyperinfection strongyloidiasis in a liver transplant recipient treated with parenteral ivermectin

Lichtenberger, Paola; Rosa-Cunha, Isabella; Morris, Michele; Nishida, Seigo; Akpınar, Ersin; Gaitan, John Stiven Montoya; Tzakis, Andreas G.; Doblecki-Lewis, Susanne

doi:10.1111/j.1399-3062.2008.00358.x

Cited by 37 publications

(34 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, recent reports have shown that serum ivermectin concentration is very low after rectal administration in patients sustaining paralytic ileus or intestinal obstruction [34,35]. No parenteral preparation of these anthelmintics is available for use in humans, although subcutaneous veterinary ivermectin has been utilized successfully in the treatment of strongyloidiasis unresponsive to standard oral therapy or when enteral administration is not feasible [34-36]. Thus, further studies assessing safety, efficacy and pharmacokinetics of parenteral ivermectin are needed in order improve the treatment and outcome of patients sustaining this unusual complication of Strongyloides stercoralis hyperinfection.…”

Section: Discussionmentioning

confidence: 99%

Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report

2010

View full text Add to dashboard Cite

BackgroundIntestinal obstruction is a poorly recognized and probably underreported complication of strongyloidiasis. We present herein an unusual case, of complete duodenal obstruction caused by S. stercoralis.MethodsA systematic review of the literature examining the clinical course, diagnostic methods, and outcome of this rare complication of strongyloidiasis was performed.ResultsA 42-year-old woman presented with a 5-month history of abdominal pain, vomit, and weight loss. An abdominal CT scan showed an obstruction of the third part of the duodenum. Segmental intestinal resection was carried out and histopathology examination revealed heavy Strongyloides stercoralis infestation. Duodenal obstruction is a rare complication of S. stercoralis infection, with only 8 cases described in the literature since 1970. Most of the patients are males, middle-aged, and the diagnosis was made by duodenal aspirate/biopsy, or analysis of surgical specimen.ConclusionsDuodenal obstruction is an unusual, but potential fatal, complication of S. stercoralis infection. The large spectrum of clinical manifestation and lack of classic clinical syndrome make the final diagnosis of strongyloidiasis extremely difficult. A high index of suspicion, mainly in patients from endemic areas, is needed for correct and early diagnosis of this uncommon presentation of Strogyloides stercoralis enteritis.

show abstract

Section: Discussionmentioning

confidence: 99%

Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report

2010

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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...

show abstract

“…The drugs, while reasonably well tolerated, can cause adverse effects including liver disfunction, gastrointestinal symptoms (nausea, vomiting, loose stool, abdominal distension or pain), chest tightness or pain, itching, fever, cough and wheezing, dizziness, and neurological effects [50,51,52,53]. Another issue with anthelminthic drugs is their teratogenicity potential in pregnant women who have a high risk of developing iron-deficiency anemia [54].…”

Section: Anthelminthic Drugsmentioning

confidence: 99%

Advocating for both Environmental and Clinical Approaches to Control Human Strongyloidiasis

2016

View full text Add to dashboard Cite

Strongyloidiasis is an underestimated disease caused by the soil-transmitted parasite of the genus Strongyloides. It is prevalent in socioeconomically disadvantaged communities and it is estimated that global infection could be as high as 370 million people. This paper explores current methods of strongyloidiasis treatment, which rely on administration of anthelminthic drugs. However these drugs cannot prevent reinfection and drug resistance has already been observed in veterinary models. This highlights the need for a combined approach for controlling Strongyloides that includes both clinical treatment and environmental control methods. Currently, nematicides are widely used to control plant parasites. The review suggests that due to the species’ similarity and similar modes of action, these nematicides could also be used to control animal and human parasitic nematodes in the environment.

show abstract

Hyperinfection strongyloidiasis in a liver transplant recipient treated with parenteral ivermectin

Cited by 37 publications

References 25 publications

Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report

Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report

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

Advocating for both Environmental and Clinical Approaches to Control Human Strongyloidiasis

Contact Info

Product

Resources

About