Subcutaneous ivermectin for the treatment of the hyperinfection syndrome by Strongyloides stercoralis

Abstract

Strongyloidiasis is a disease caused by the nematode Strongyloides stercoralis that is endemic in rural regions in tropical and subtropical countries. Immunosuppressed patients have an increased risk of infection by this parasite and are at risk of developing a hyperinfection syndrome which involves a higher risk of death. The syndrome is treated with ivermectin, however, there is no parenteral presentation of this medication for human use in Colombia or the world, which is an important problem in patients who have compromised enteral absorption, for instance, those with intestinal obstructions. We present a case of hyperinfection syndrome by Strongyloides stercoralis in Colombia, which was treated with subcutaneous ivermectin. Our purpose is to encourage pharmacokinetic and pharmacodynamic studies to establish this route of administration in the future as an alternative for those patients who have a high risk of therapeutic failure with the oral route.

Keywords: Strongyloidiasis/drug therapy; ivermectin; subcutaneous injection; intestinal obstruction; immunosuppression.

Figura 1. Tomografía computarizada de tórax: áreas de consolidación y atelectasias en ambos lóbulos inferiores

Figura 2. Tomografía computarizada de abdomen: dilatación del íleon distal, con engrosamiento de las paredes y signo de “fecalización” del contenido intraluminal (small-bowel feces sign), indicativos de posible obstrucción intestinal parcial

Figura 3. Extendido del lavado broncoalveolar: dos larvas correspondientes a Strongyloides stercoralis