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Rojas OC, Montoya AM, Villanueva-Lozano H, Carrion-Alvarez D. Severe strongyloidiasis: a systematic review and meta-analysis of 339 cases. Trans R Soc Trop Med Hyg 2023; 117:682-696. [PMID: 37300462 DOI: 10.1093/trstmh/trad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/15/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Strongyloidiasis is a parasitosis representing a significant public health problem in tropical countries. It is often asymptomatic in immunocompetent individuals but its mortality rate increases to approximately 87% in severe forms of the disease. We conducted a systematic review, including case reports and case series, of Strongyloides hyperinfection and dissemination from 1998 to 2020 searching PubMed, EBSCO and SciELO. Cases that met the inclusion criteria of the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were analysed. Statistical analysis was performed using Fisher's exact test and Student's t-test and a Bonferroni correction for all the significant values. A total of 339 cases were included in this review. The mortality rate was 44.83%. The presence of infectious complications, septic shock and a lack of treatment were risk factors for a fatal outcome. Eosinophilia and ivermectin treatment were associated with an improved outcome.
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Affiliation(s)
- Olga C Rojas
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Alexandra M Montoya
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Hiram Villanueva-Lozano
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
| | - Diego Carrion-Alvarez
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
- Departamento de Ciencias Basicas, Universidad de Monterrey. N.L. Mexico. Av. Ignacio Morones Prieto 4500, San Pedro, Garza García, Nuevo Leon, Mexico
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2
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Mandalaywala R, Rana A, Ramos AL, Sampson P, Ashkenas J. Physical and pharmacokinetic characterization of Soluvec™, a novel, solvent-free aqueous ivermectin formulation. Ther Deliv 2023; 14:391-399. [PMID: 37535333 DOI: 10.4155/tde-2023-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Purpose: To describe application of the Quicksol™ solvent-free approach to solubilize ivermectin (IVM). Methods: Lyophilized IVM complexed with hydroxypropyl-β-cyclodextrin (HP-β-CD) was resolubilized in aqueous polysorbate-80, generating Soluvec™. Lyophilizate was examined by Fourier-transform infrared spectroscopy and differential scanning calorimetry; Soluvec, by dynamic light scattering. Pharmacokinetics was evaluated in dogs allocated to subcutaneous (SC) or intramuscular (IM) Soluvec or oral IVM. Results: IVM in Soluvec was tightly bound by HPβCD, forming nearly monodisperse 28 nm particles with solubility ∼2500-times that of free IVM. SC and IM Soluvec increased IVM exposure, peak IVM and extended duration of IVM exposure, versus oral dosing. Conclusion: The Quicksol method generated Soluvec, a concentrated aqueous parenteral IVM formulation with pharmacokinetic properties suitable for veterinary or human use.
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Affiliation(s)
- Richa Mandalaywala
- Mountain Valley MD, 260 Edgeley Blvd - Unit 4, Concord, Ontario, L4K 3Y4, Canada
| | - Azhar Rana
- Mountain Valley MD, 260 Edgeley Blvd - Unit 4, Concord, Ontario, L4K 3Y4, Canada
| | - Aubrey L Ramos
- Mountain Valley MD, 260 Edgeley Blvd - Unit 4, Concord, Ontario, L4K 3Y4, Canada
| | - Peter Sampson
- IntrinsiChem Consulting Inc., Oakville, Ontario, L6M 4A2, Canada
| | - John Ashkenas
- EquiPoise Communication, 491 Brunswick Ave, Toronto, Ontario, M5R 2Z6, Canada
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3
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Dos Passos JBS, Coelho LV, de Arruda JAA, Silva LVDO, do Valle IB, Santos MDS, de Figueiredo EL, Abreu LG, Mesquita RA. Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020. SPECIAL CARE IN DENTISTRY 2020; 41:20-31. [PMID: 33125723 DOI: 10.1111/scd.12533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/19/2023]
Abstract
Myiasis is an infection caused by the deposition of fly larvae in tissues, and its involvement in the human oral cavity is uncommon. Herein, we have performed a data analysis of published cases of oral myiasis. A search was performed in PubMed, Ovid, Web of Science, Scopus, and LILACS. Geographic distribution, demographic data, associated factors, clinical features, fly types, treatment, and presence of sequelae were analyzed. A total of 122 articles reported the cases of 157 infected individuals. The most affected countries were India (41%) and Brazil (29.5%). Male predominance (67.5%) and a mean of 41.9 years of age were observed. The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%). There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing. The establishment of a standard treatment protocol, enabling comparison in future studies and providing uniformity in treatment strategies offered by health services is strongly recommended.
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Affiliation(s)
- Juliana Bianchi Souza Dos Passos
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luiza Vale Coelho
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leni Verônica de Oliveira Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella Bittencourt do Valle
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana de Souza Santos
- Department of Morphology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Eugênia Leal de Figueiredo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, Pernambuco, Brazil
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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4
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La Hoz RM, Morris MI. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13618. [PMID: 31145496 DOI: 10.1111/ctr.13618] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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5
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Boodman C, Chhonker YS, Murry DJ, Mah A, Grant J, Steiner T, Libman M, Nishi C, Charles M. Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy. Am J Trop Med Hyg 2018; 99:1194-1197. [PMID: 30226142 DOI: 10.4269/ajtmh.18-0487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Disseminated strongyloidiasis is often fatal, despite treatment with oral albendazole and parenteral ivermectin (IVM). Here, we report elevated plasma IVM and albendazole sulfoxide concentrations in the context of extracorporeal membrane oxygenation and continuous renal replacement therapy in a patient with disseminated strongyloidiasis treated with subcutaneous IVM and nasogastric albenzadole. Despite elevated drug plasma concentrations, live filariform larvae were detected in endotracheal aspirates after 2 weeks of treatment.
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Affiliation(s)
- Carl Boodman
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Daryl J Murry
- University of Nebraska Medical Centre, Omaha, Nebraska
| | - Allison Mah
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer Grant
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Theodore Steiner
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Libman
- J. D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Cesilia Nishi
- Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Marthe Charles
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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6
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Zeitler K, Jariwala R, Restrepo-Jaramillo R, Kapadia S, Casanas B, Alrabaa S, Sriaroon C. Successful use of subcutaneous ivermectin for the treatment of Strongyloides stercoralis hyperinfection in the setting of small bowel obstruction and paralytic ileus in the immunocompromised population. BMJ Case Rep 2018; 2018:bcr-2017-223138. [PMID: 29866667 PMCID: PMC5990086 DOI: 10.1136/bcr-2017-223138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Kristen Zeitler
- Department of Pharmacy, Tampa General Hospital, Tampa, Florida, USA
| | - Ripal Jariwala
- Department of Pharmacy, Tampa General Hospital, Tampa, Florida, USA
| | | | - Shyam Kapadia
- Division of Pulmonary and Critical Care Medicine, University of South Florida, Tampa, Florida, USA
| | - Beata Casanas
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, US
| | - Sally Alrabaa
- Division of Infectious Diseases and International Medicine, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, US
| | - Chakrapol Sriaroon
- Division of Pulmonary and Critical Care Medicine, University of South Florida, Tampa, Florida, USA
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7
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Grossi PA, Lombardi D, Petrolo A, Rovelli C, Di Rosa Z, Perriccioli G, Rossi A, Minoja G, Scaglione F, Dalla Gasperina D. Strongyloides stercoralis Hyperinfection in an HIV-Infected Patient Successfully Treated with Subcutaneous Ivermectin. Trop Med Infect Dis 2018; 3:tropicalmed3020046. [PMID: 30274442 PMCID: PMC6073990 DOI: 10.3390/tropicalmed3020046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 01/25/2023] Open
Abstract
A 39-year-old Ethiopian HIV-positive man with peripheral T-cell lymphoma developed Strongyloides stercoralis hyperinfection. The patient was initially treated with oral ivermectin for three weeks without response, most likely due to malabsorption because of concomitant paralytic ileus. Given the persistence of larvae in the body fluids, the worsening respiratory status and clinical malabsorption, veterinary parenteral formulation of ivermectin was administered. The very high plasma concentration of ivermectin achieved in the patient after parenteral administration led to a rapid improvement in his clinical condition and rapid disappearance of the parasite from biological samples, without any adverse reaction.
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Affiliation(s)
- Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Domenico Lombardi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Alessia Petrolo
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Cristina Rovelli
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | - Zaira Di Rosa
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
| | | | - Agostino Rossi
- Laboratory of Medical Microbiology, ASST Sette Laghi, 21100 Varese, Italy.
| | - Giulio Minoja
- Intensive Care Unit, ASST Sette Laghi, 21100 Varese, Italy.
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, 20129 Milan, Italy.
| | - Daniela Dalla Gasperina
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
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8
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Abstract
The majority of the 30-100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics - including new immunoassays and molecular tests - will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.
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9
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Ivermectina subcutánea en estrongiloidiasis diseminada: a propósito de la autorización de un medicamento veterinario para uso humano. Med Clin (Barc) 2016; 146:376-7. [DOI: 10.1016/j.medcli.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/18/2015] [Accepted: 10/22/2015] [Indexed: 11/18/2022]
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10
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Barrett J, Broderick C, Soulsby H, Wade P, Newsholme W. Subcutaneous ivermectin use in the treatment of severe Strongyloides stercoralis infection: two case reports and a discussion of the literature. J Antimicrob Chemother 2016; 71:220-5. [PMID: 26462990 DOI: 10.1093/jac/dkv315] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis infection presents with varying degrees of severity, but it often primarily involves the small bowel. In severe infection and cases of hyperinfection, ileus and small-bowel obstruction may prevent enteral absorption of anthelminthics such as ivermectin. At present there are no parenteral anthelminthics licensed for use in humans. METHODS Here, we describe two cases of severe S. stercoralis infection treated with an unlicensed veterinary preparation of subcutaneous ivermectin, and we discuss the published reports of the use of this treatment elsewhere. RESULTS Both patients were successfully treated with subcutaneous ivermectin, and both recovered completely. CONCLUSIONS 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.
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Affiliation(s)
- Jessica Barrett
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Claire Broderick
- Department of Infectious Diseases, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Hannah Soulsby
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Paul Wade
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - William Newsholme
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Bogoch II, Khan K, Abrams H, Nott C, Leung E, Fleckenstein L, Keystone JS. Failure of ivermectin per rectum to achieve clinically meaningful serum levels in two cases of Strongyloides hyperinfection. Am J Trop Med Hyg 2015; 93:94-6. [PMID: 25918215 DOI: 10.4269/ajtmh.15-0077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/11/2015] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Isaac I Bogoch
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Kamran Khan
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Howard Abrams
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Caroline Nott
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Elizabeth Leung
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Lawrence Fleckenstein
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
| | - Jay S Keystone
- Division of General Internal Medicine, University Health Network, Toronto, Canada; Division of Infectious Diseases, University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada; Department of Pharmacy, St. Michael's Hospital, Toronto, Canada; Division of Pharmaceutics and Translational Therapeutics, University of Iowa, Iowa City, Iowa
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Donadello K, Cristallini S, Taccone FS, Lorent S, Vincent JL, de Backer D, Jacobs F. Strongyloides disseminated infection successfully treated with parenteral ivermectin: case report with drug concentration measurements and review of the literature. Int J Antimicrob Agents 2013; 42:580-3. [DOI: 10.1016/j.ijantimicag.2013.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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13
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Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 2013; 13:78. [PMID: 23394259 PMCID: PMC3598958 DOI: 10.1186/1471-2334-13-78] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 01/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis. METHODS We conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions. RESULTS Records screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%). CONCLUSIONS Proper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ana Requena-Mendez
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Andrea Angheben
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jose Muñoz
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Federico Gobbi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jef Van Den Ende
- Department of Clinical sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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14
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Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 2012; 25:458-63. [PMID: 22691685 PMCID: PMC3430846 DOI: 10.1097/qco.0b013e3283551dbd] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review discusses the latest approaches to the diagnosis and treatment of patients with strongyloidiasis, with an emphasis on infection in the immunocompromised host and the risk for disseminated strongyloidiasis. RECENT FINDINGS The differences in acute, chronic, accelerated autoinfection, and disseminated disease in Strongyloides stercoralis infection are explored with particular emphasis on early diagnosis, treatment, and prevention. The goals of treatment are investigated for the different infection states. Predisposing risks for dissemination are delineated, and the roles played for newer diagnostics in the identification of at-risk individuals are detailed. SUMMARY The use of newer diagnostic tests and broader screening of immunocompromised patients from Strongyloides-endemic areas is of paramount importance, particularly if prevention of life-threatening dissemination is the goal.
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Affiliation(s)
- Rojelio Mejia
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-0425, USA
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Duque FL, Ardila CM. Oral myiasis caused by the screwworm Cochliomyia hominivorax treated with subcutaneous ivermectin and creolin: report of six cases after trauma. Dent Traumatol 2011; 27:404-7. [PMID: 21535400 DOI: 10.1111/j.1600-9657.2011.01004.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Marcos LA, Terashima A, Canales M, Gotuzzo E. Update on strongyloidiasis in the immunocompromised host. Curr Infect Dis Rep 2011; 13:35-46. [PMID: 21308453 DOI: 10.1007/s11908-010-0150-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Immunocompromised persons are the most vulnerable population at risk for developing life-threatening clinical syndromes associated with strongyloidiasis, such as hyperinfection syndrome (HS) or dissemination. This review focuses on describing Strongyloides infection in the immunocompromised host, including immune response against this infection, analyzing the cases with HS published during the past 4 years in the United States, and describing the most sensitive diagnostic tools and the most effective treatment for each clinical syndrome. Strongyloidiasis is becoming an important parasitic disease in the United States, especially in the immunocompromised immigrant population. Because the transplant population is particularly at risk for developing HS, both recipients and donors should be screened for Strongyloides. Clinicians should also be aware that the development of HS can follow unexpectedly a few days after appropriate anthelminthic therapy. Highly sensitive screening tests are still not available in the major tertiary medical centers. Parenteral ivermectin has been used in some severe cases. Further therapy developments and improving diagnostic tools are warranted.
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Affiliation(s)
- Luis A Marcos
- Infectious Diseases Division, Internal Medicine Department, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA,
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Fusco DN, Downs JA, Satlin MJ, Pahuja M, Ramos L, Barie PS, Fleckenstein L, Murray HW. Non-oral treatment with ivermectin for disseminated strongyloidiasis. Am J Trop Med Hyg 2010; 83:879-83. [PMID: 20889884 DOI: 10.4269/ajtmh.2010.10-0258] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Critically ill patients with disseminated strongyloidiasis may not be candidates for oral treatment. We report four patients with disseminated strongyloidiasis, believed to be unable to absorb oral therapy, who were treated with ivermectin by rectal and/or subcutaneous administration. Obtaining subcutaneous ivermectin and dosing it appropriately is a challenge. These cases underscore the need for improved access to subcutaneous ivermectin and more pharmacological data to guide use of this treatment approach.
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Affiliation(s)
- Dahlene N Fusco
- Division of Infectious Diseases, and Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
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Cruz RJ, Vincenzi R, Ketzer BM. Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report. World J Emerg Surg 2010; 5:23. [PMID: 20698992 PMCID: PMC2925357 DOI: 10.1186/1749-7922-5-23] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 08/10/2010] [Indexed: 11/27/2022] Open
Abstract
Background Intestinal 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. Methods A systematic review of the literature examining the clinical course, diagnostic methods, and outcome of this rare complication of strongyloidiasis was performed. Results A 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. Conclusions Duodenal 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.
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Affiliation(s)
- Ruy J Cruz
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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