Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment.

INTRODUCTION: Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. AREAS COVERED: Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. EXPERT OPINION: The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.

Combination therapy for disseminated strongyloidiasis with associated vancomycin-resistant, linezolid-intermediate Enterococcus faecium meningitis: A case report.

WHAT IS KNOWN AND OBJECTIVE: The rhabditid nematode Strongyloides stercoralis is the major causative agent of disseminated strongyloidiasis (DS). In rare cases, DS has caused enterococcal meningitis. If DS-associated vancomycin-resistant Enterococcus faecium (VRE) meningitis is suspected, combination antibiotic therapy should be considered. CASE SUMMARY: We present a case of a 61-year-old male who developed DS associated with vancomycin-resistant and linezolid-intermediate E. faecium meningitis after receiving corticosteroids. The VRE meningitis was treated with high-dose daptomycin 12 mg/kg, linezolid, tigecycline and quinupristin/dalfopristin. Despite negative cultures, the patient expired. WHAT IS NEW AND CONCLUSION: In patients with DS-associated VRE meningitis, early use of combination therapy may be warranted to improve patient outcomes.

Strongyloides stercolaris en un paciente con artritis reumatoide en tratamiento con etanercept / Strongyloides stercolaris in a patient with rheumatoid arthritis undergoing treatment with Etanercept

La terapia biológica para el tratamiento de enfermedades autoinmunitarias, como la artritis reumatoide, conlleva una serie de efectos secundarios y complicaciones cada vez más frecuentes y de gran complejidad tanto en el manejo como en la comorbilidad asociada. Presentamos el caso de un paciente con una de estas complicaciones asociada (AU)

Biologic therapy for the treatment of autoimmune diseases such as rheumatoid arthritis leads to a series of secondary effects and complications which are ever more frequent and increasingly complicate both the management as well as the associated comorbidity. We present the case of a patient who had one of theses associated complications (AU)