Successful use of subcutaneous ivermectin for the treatment ofStrongyloides stercoralishyperinfection in the setting of small bowel obstruction and paralytic ileus in the immunocompromised population

Abstract

Severe Strongyloides stercoralis, such as hyperinfection syndrome, carries a high mortality risk. Even with appropriate treatment, patients may experience infectious complications and failure of therapy. Currently, there are no Food and Drug Administration–approved parenteral therapies available for treatment in patients who develop gastrointestinal complications from hyperinfection, including small bowel obstruction. A veterinary form of ivermectin is available as a subcutaneous injection, although current literature in humans is limited. We report on the successful treatment of two surviving immunocompromised patients with S. stercoralis hyperinfection syndrome after prompt recognition and initiation of veterinary subcutaneous ivermectin therapy.

Ivermectina subcutánea en el tratamiento de un síndrome de hiperinfección por Strongyloides stercoralis

“…Según el artículo de Barret, et al 13 , las dosis diarias usadas en los reportes de casos hasta la fecha han oscilado entre 75 y 285 μg/kg (6 a 22 mg por dosis) y entre tres y 11 dosis. En 13 de los 23 casos reportados, los pacientes sobrevivieron y alcanzaron la cura microbiológica, siete alcanzaron la cura microbiológica, aunque murieron de complicaciones durante la hospitalización, y tres murieron durante el tratamiento 13 , 15 .…”

“…Aunque las dosis diarias han variado, en la mayoría de los casos se usó una de 200 μg/kg, es decir, la máxima de la presentación oral 13 , 15 .No obstante, no hay estudios de farmacocinética o farmacodinámica en humanos 13 , 15 que ayuden a determinar el comportamiento de la ivermectina administrada por vía subcutánea y a establecer la frecuencia de su administración, la dosis máxima tolerada y la dosis segura en humanos, entre otros datos relevantes.…”

Strongyloidiasis in Solid Organ Transplantation

“…In patients who are unable to tolerate oral ivermectin, alternative routes of administration may be required. In patients with paralytic ileus, ivermectin absorption may be impaired even if administered via nasogastric tube [48,79]. Rectal ivermectin (200 μg/kg/day) has been used with occasional success *48, 79].…”

“…Rectal ivermectin (200 μg/kg/day) has been used with occasional success *48, 79]. A veterinary subcutaneous ivermectin formulation (200 μg/kg/day in divided doses into each arm), recognized by the Centers for Disease Control and Prevention as a therapeutic option when oral and/or rectal ivermectin administration is not possible, requires an investigational new drug exemption from the US FDA and has been used with mixed results [48,79,80].…”

Laboratory Findings on a Patient with Strongyloies Stercoralis Pulmonary Infection after Long Term Steroid Hormone and Immunosuppressive Treatment

“…Occasionally, the adult worms also migrate to the lungs, genitourinary system, kidney, liver or brain. Infection of the intestine and the lungs are more frequent, and thus digestive and respiratory symptoms are more common [1,9,10]. The manifestations The patient had high blood leukocytes, neutrophils, and eosinophils counts, elevated immunoglobulin E, C-reactive protein, and procalcitonin, indicating a pulmonary infection (parasitic and bacterial) ( Table 1).…”