Strongyloides disseminated infection successfully treated with parenteral ivermectin: case report with drug concentration measurements and review of the literature

We report the case of an immunosuppressed patient with Strongyloides disseminated infection who was successfully treated with the veterinary parenteral form of ivermectin. A kidney transplant recipient developed disseminated infection with Strongyloides stercoralis. Because oral treatment with iverm...

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Bibliographic Details
Published in:International journal of antimicrobial agents 2013-12, Vol.42 (6), p.580-583
Main Authors: Donadello, Katia, Cristallini, Stefano, Taccone, Fabio Silvio, Lorent, Sophie, Vincent, Jean-Louis, de Backer, Daniel, Jacobs, Frédérique
Format: Article
Language:English
Subjects:
Animals
Anthelmintics - administration & dosage
Anthelmintics - pharmacokinetics
blood serum
case studies
Disseminated infection
drugs
encephalopathy
Humans
Hyperinfection
Infectious Disease
Injections, Subcutaneous
Ivermectin
Ivermectin - administration & dosage
Ivermectin - pharmacokinetics
kidney transplant
larvae
Male
Middle Aged
oral administration
patients
Serum - chemistry
Serum concentration
Strongyloides stercoralis
Strongyloides stercoralis - drug effects
Strongyloidiasis - drug therapy
Strongyloidiasis - parasitology
Treatment Outcome
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Summary:We report the case of an immunosuppressed patient with Strongyloides disseminated infection who was successfully treated with the veterinary parenteral form of ivermectin. A kidney transplant recipient developed disseminated infection with Strongyloides stercoralis. Because oral treatment with ivermectin was not possible, subcutaneous ivermectin (75µg/kg/day, then 200µg/kg/day) was given for 9 days, with clinical improvement and disappearance of all larvae. Serum ivermectin concentrations were between 15.6ng/mL and 19.7ng/mL during the 9 days of therapy; however, drug accumulation (plasma levels >40ng/mL) 48h after discontinuation of therapy was associated with the development with encephalopathy. We also review all cases of human disseminated Strongyloides infection treated with parenteral ivermectin.
ISSN:0924-8579
1872-7913
DOI:10.1016/j.ijantimicag.2013.07.015