Case Report: Subcutaneous Ivermectin Pharmacokinetics in Disseminated Strongyloides Infection: Plasma and Postmortem Analysis

Pamela Konecny St. George Hospital, Sydney, Australia;
University of New South Wales, Sydney, Australia;

Search for other papers by Pamela Konecny in
Current site
Google Scholar
PubMed
Close
,
Christopher J. Weatherall St. George Hospital, Sydney, Australia;
University of New South Wales, Sydney, Australia;

Search for other papers by Christopher J. Weatherall in
Current site
Google Scholar
PubMed
Close
,
Suman Adhikari St. George Hospital, Sydney, Australia;
University of New South Wales, Sydney, Australia;

Search for other papers by Suman Adhikari in
Current site
Google Scholar
PubMed
Close
,
Johan Duflou Forensic Medicine Associates P/L, Sydney, Australia;
University of Sydney, Sydney, Australia;

Search for other papers by Johan Duflou in
Current site
Google Scholar
PubMed
Close
,
Veli Marjoniemi St. George Hospital, Sydney, Australia;
University of New South Wales, Sydney, Australia;

Search for other papers by Veli Marjoniemi in
Current site
Google Scholar
PubMed
Close
,
Carel J. Pretorius Pathology Queensland, Brisbane, Australia;
School of Biomedical Sciences, University of Queensland, Brisbane, Australia

Search for other papers by Carel J. Pretorius in
Current site
Google Scholar
PubMed
Close
, and
Brett McWhinney Pathology Queensland, Brisbane, Australia;

Search for other papers by Brett McWhinney in
Current site
Google Scholar
PubMed
Close
Restricted access

Parenteral ivermectin treatment of disseminated strongyloidiasis and hyperinfection is increasing, although not licensed in humans and with limited pharmacokinetic data available. Plasma and postmortem tissue analysis in an human immunodeficiency virus (HIV)/hepatitis C virus–positive man with disseminated strongyloidiasis suggests loading subcutaneous ivermectin doses are required, from which the central nervous system is protected.

Author Notes

Address correspondence to Pamela Konecny, Department of Infectious Diseases, Immunology and Sexual Health, St. George Hospital, 2 South St., Sydney 2217, New South Wales, Australia. E-mail: pam.konecny@health.nsw.gov.au

Authors’ addresses: Pamela Konecny and Christopher J. Weatherall, Department of Infectious Diseases, Immunology and Sexual Health, St. George Hospital, Sydney, Australia, E-mails: pam.konecny@health.nsw.gov.au and chris.weatherall@health.nsw.gov.au. Suman Adhikari, Department of Pharmacy, St. George Hospital, Sydney, Australia, E-mail: suman.adhikari@health.nsw.gov.au. Johan Duflou, Forensic Medicine Associates P/L, Sydney, Australia, E-mail: jduflou@forensicmedicine.com.au. Veli Marjoniemi, Department of Anatomical Pathology, St. George Hospital, Sydney, Australia, E-mail: veli.marjoniemi@health.nsw.gov.au. Carel J. Pretorius and Brett McWhinney, Pathology Queensland, Brisbane, Australia, E-mails: carel.pretorius@health.qld.gov.au and brett.mcwhinney@health.qld.gov.au.

  • 1.

    Bisoffi Z et al. 2013. Strongyloides stercoralis: a plea for action. PLoS Negl Trop Dis 7: e2214.

  • 2.

    Puthiyakunnon S, Boddu S, Li Y, Zhou X, Wang C, Li J, Chen X, 2014. Strongyloidiasis—an insight into its global prevalence and management. PLoS Negl Trop Dis 8: e3018.

  • 3.

    Mobley CM, Dhala A, Ghobrial RM, 2017. Strongyloides stercoralis in solid organ transplantation: early diagnosis gets the worm. Curr Opin Organ Transpl 22: 336344.

  • 4.

    Mejia R, Nutman T, 2012. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 25: 458463.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z, 2013. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 13: 7888.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    US FDA, Stromectal® (Ivermectin). Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/050742s022lbl.pdf. Accessed May 5, 2018.

    • PubMed
    • Export Citation
  • 7.

    Barrett J, Broderick C, Soulsby H, Wade P, Newsholme W, 2016. Subcutaneous ivermectin use in the treatment of severe Strongyloides stercoralis infection: two case reports and a discussion of the literature. J Antimicrob Chemother 71: 220225.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Looke DFM, McCarthy KL, McWhinney B, Clague A, Pillans P, 2005. Strongyloides hyperinfection syndrome: low serum levels of ivermectin after oral and subcutaneous administration. Intern Med J 35: A73A88.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Albonico M et al. 2016. StrongNet: an international network to improve diagnostics and access to treatment for strongyloidiasis control. PLoS Negl Trop Dis 10: e0004898.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Einsiedel L, Fernandes L, 2008. Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in central Australia. Intern Med J 38: 697703.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Abdolrasouli A, McMillan A, Ackers JP, 2009. Sexual transmission of intestinal parasites in men who have sex with men. Sex Health 6: 185194.

  • 12.

    Qu Z, Kundu UR, Abadeer RA, Wanger A, 2009. Strongyloides colitis is a lethal mimic of ulcerative colitis: the key morphologic differential diagnosis. Hum Pathol 40: 572577.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Guzzo CA, Furtek CI, Porras AG, Chen C, Tipping R, Clineschmidt CM, Sciberras DG, Hsieh JY, Lasseter KC, 2002. Safety, tolerability, and pharmacokinetics of escalating high doses of ivermectin in healthy adult subjects. J Clin Pharmacol 42: 11221133.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Edwards G, 2003. Ivermectin: does P-glycoprotein play a role in neurotoxicity? Filaria J 2 (Suppl 1): S8.

  • 15.

    González Canga A, Sahagún Prieto AM, Diez-Liébana MJ, Fernández Martínez N, Sierra Vega M, García Vieitez JJ, 2008. The pharmacokinetics and interactions of ivermectin in humans—a mini-review. AAPS J 10: 4246.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Steel JW, 1993. Pharmacokinetics and metabolism of avermectins in livestock. Vet Parasitol 48: 4557.

Past two years Past Year Past 30 Days
Abstract Views 224 161 19
Full Text Views 597 14 0
PDF Downloads 251 14 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save