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

• 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
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2013.07.015

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.