Pharmacological treatment of strongyloidiasis in humans: an integrative review
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i5e-210459Keywords:
Strongyloidiasis, Review, Covid-19 Drug TreatmentAbstract
Introduction: Strongyloidiasis is an endemic parasitosis in Brazil and in whole world, caused by Strongyloides stercoralis, which stands out for its ability to cause autoinfection in the host, which can lead to serious conditions in situations of immunosuppression. Currently, medicine has a limited therapeutic arsenal for this condition. Objective: To describe the recommendations, new possibilities and efficiency of the most current treatments for strongyloidiasis. Method: This is an integrative literature review, using the PUBMED, Virtual Health Library and SciELO databases, of publications from the last 5 years and with a high level of evidence. Results: After applying the eligibility criteria, 10 studies were selected to be analyzed qualitatively. Discussion: The standard treatment for strongyloidiasis remains oral ivermectin, reserving albendazole and thiabendazole as second-line therapy. Strongyloidiasis screening and treatment is recommended for all patients requiring immunosuppressive therapy, including corticosteroid therapy for COVID-19 or use of methotrexate. Although not recommended for children weighing less than 15 kg due to lack of safety studies, ivermectin has already been used in this population in certain situations, without major adverse effects. It is even recommended, in a diluted form, by the French Medicines Regulatory Agency, for younger children. Moxidectin is being studied as a possible alternative to ivermectin because it mainly offers some pharmacokinetic advantages. In hyperinfection syndrome, a veterinary formulation of subcutaneous ivermectin has been used in patients who cannot tolerate the oral route. Conclusion: Discreet advances have been made regarding pharmacological therapy for strongyloidiasis. Among the main demands, the urgency of clinical studies that test parenteral ivermectin and its safety in children below 15 kg stands out.
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References
Bisoffi Z, Buonfrate D, Montresor A, Requena-Méndez A, Muñoz J, et al. Strongyloides stercoralis: a plea for action. PLoS Negl Trop Dis. 2013;7(5):e2214. doi: 10.1371/journal.pntd.0002214.
Buonfrate D, Bisanzio D, Giorli G, Odermatt P, Fürst T, et al. The global prevalence of strongyloides stercoralis infection. Pathogens. 2020;9(6):468. doi: 10.3390/pathogens9060468.
Schär F, Trostdorf U, Giardina F, Khieu V, Muth S, et al. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis. 2013;7(7):e2288. doi: 10.1371/journal.pntd.0002288.
Buonfrate D, Mena MA, Angheben A, Requena-Mendez A, Muñoz J, et al. COHEMI Project Study Group. prevalence of strongyloidiasis in Latin America: a systematic review of the literature. Epidemiol Infect. 2015;143(3):452-60. doi: 10.1017/S0950268814001563.
Farthing M, Albonico M, Bisoffi Z, Bundy D, Buonfrate D, et al. World gastroenterology organisation global guidelines: management of strongyloidiasis February 2018-compact version. J Clin Gastroenterol. 2020;54(9):747-57. doi: 10.1097/MCG.0000000000001369.
La Hoz RM, Morris MI; AST Infectious diseases community of practice. intestinal parasites including cryptosporidium, cyclospora, giardia, and microsporidia, entamoeba histolytica, strongyloides, schistosomiasis, and echinococcus: guidelines from the american society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33(9):e13618. doi: 10.1111/ctr.13618.
Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis. 2013;13:78. doi: 10.1186/1471-2334-13-78.
Keiser PB, Nutman TB. Strongyloides stercoralis in the Immunocompromised Population. Clin Microbiol Rev. 2004;17(1):208-17. doi: 10.1128/CMR.17.1.208-217.2004.
Siegel MO, Simon GL. Is human immunodeficiency virus infection a risk factor for Strongyloides stercoralis hyperinfection and dissemination. PLoS Negl Trop Dis. 2012;6(7):e1581. doi: 10.1371/journal.pntd.0001581.
Lier AJ, Tuan JJ, Davis MW, Paulson N, McManus D, et al. Case Report: disseminated strongyloidiasis in a patient with COVID-19. Am J Trop Med Hyg. 2020 Oct;103(4):1590-1592. doi: 10.4269/ajtmh.20-0699.
Centers for disease control and prevention. Parasites-strongyloides. Resources for health professionals. Atlanta, GA: Centers for disease control and prevention; 2016. Available from: www.cdc.gov/parasites/strongyloides/health_professionals/index.html.
González A, Gallo M, Valls ME, Muñoz J, Puyol L, et al. Clinical and epidemiological features of 33 imported Strongyloides stercoralis infections. Trans R Soc Trop Med Hyg. 2010;104(9):613-6. doi: 10.1016/j.trstmh.2010.06.001.
Buonfrate D, Formenti F, Perandin F, Bisoffi Z. Novel approaches to the diagnosis of Strongyloides stercoralis infection. Clin Microbiol Infect. 2015;21(6):543-52. doi: 10.1016/j.cmi.2015.04.001.
Requena-Méndez A, Buonfrate D, Gomez-Junyent J, Zammarchi L, Bisoffi Z, et al. Evidence-Based Guidelines for screening and management of strongyloidiasis in non-endemic countries. Am J Trop Med Hyg. 2017;97(3):645-652. doi: 10.4269/ajtmh.16-0923.
Nielsen PB, Mojon M. Improved diagnosis of strongyloides stercoralis by seven consecutive stool specimens. Zentralbl Bakteriol Mikrobiol Hyg A. 1987;263(4):616-8. doi: 10.1016/s0176-6724(87)80207-9.
Buonfrate D, Requena-Mendez A, Angheben A, Cinquini M, Cruciani M, et al. Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection-A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018;12(2):e0006229. doi: 10.1371/journal.pntd.0006229.
Laing R, Gillan V, Devaney E. Ivermectin - Old Drug, new tricks? Trends Parasitol. 2017;33(6):463-72. doi: 10.1016/j.pt.2017.02.004.
Henriquez-Camacho C, Gotuzzo E, Echevarria J, White Junior AC, Terashima A, et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016;16(1):CD007745. doi: 10.1002/14651858.CD007745.pub3.
Jittamala P, Monteiro W, Smit MR, Pedrique B, Specht S, et al. A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication? PLoS Negl Trop Dis. 2021;15(3):e0009144. doi: 10.1371/journal.pntd.0009144.
Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto – Enferm Florianópolis. 2008;17(4):758-64. doi.org/10.1590/S0104-07072008000400018.
Souza MT, Silva MD, Carvalho R. Integrative review: what is it? How to do it?. Einstein (São Paulo). 2010;8(1):102-6. doi.org/10.1590/S1679-45082010RW1134.
Melnyk BM, Fineout-Overholt E. Evidence-based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005.
Buonfrate D, Fittipaldo A, Vlieghe E, Bottieau E. Clinical and laboratory features of Strongyloides stercoralis infection at diagnosis and after treatment: a systematic review and meta-analysis. Clin Microbiol Infect. 2021;27(11):1621-8. doi: 10.1016/j.cmi.2021.07.016.
Bitterman A, Martins CP, Cices A, Nadendla MP. Comparison of trials using Ivermectin for COVID-19 Between regions with high and low prevalence of Strongyloidiasis: a meta-analysis. JAMA Netw Open. 2022;5(3):e223079. doi: 10.1001/jamanetworkopen.2022.3079.
Buonfrate D, Salas-Coronas J, Muñoz J, Maruri BT, Rodari P, et al. Multiple-dose versus single-dose ivermectin for Strongyloides stercoralis infection (Strong Treat 1 to 4): a multicentre, open-label, phase 3, randomised controlled superiority trial. Lancet Infect Dis. 2019;19(11):1181-90. doi: 10.1016/S1473-3099(19)30289-0.
Hofmann D, Sayasone S, Sengngam K, Chongvilay B, Hattendorf J, et al. Efficacy and safety of ascending doses of moxidectin against Strongyloides stercoralis infections in adults: a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial. Lancet Infect Dis. 2021;21(8):1151-60. doi: 10.1016/S1473-3099(20)30691-5.
Richards C, Penner J, Colmegna I, Loewen H, Melaku Z, et al. Methotrexate exposure and risk of strongyloidiasis. Trop Med Int Health. 2019;24(9):1032-41. doi: 10.1111/tmi.13288.
Hofmann D, Smit C, Sayasone S, Pfister M, Keiser J. Optimizing moxidectin dosing for Strongyloides stercoralis infections: insights from pharmacometric modeling. Clin Transl Sci. 2022;15(3):700-8. doi: 10.1111/cts.13189.
Berthe-Aucejo A, Prot-Labarthe S, Pull L, Lorrot M, Touratier S, et al. Traitement de la gale et rupture d'Ascabiol(®) : quid de la population pédiatrique ? Gale chez l'enfant et rupture d'Ascabiol(®) [Treatment of scabies and Ascabiol(®) supply disruption: what about the pediatric population?]. Arch Pediatr. 2014;21(6):670-5. French. doi: 10.1016/j.arcped.2014.03.001.
Kobylinski K, von Seidlein L. Ivermectin safetyin small children (NCT04332068). University of Oxford; 2020.
Greaves D, Coggle S, Pollard C, Aliyu SH, Moore EM. Strongyloides stercoralis infection. BMJ. 2013 Jul 30;347:f4610. doi: 10.1136/bmj.f4610.
Chiodini PL, Reid AJ, Wiselka MJ, Firmin R, Foweraker J. Parenteral ivermectin in Strongyloides hyperinfection. Lancet. 2000;355(9197):43-4. doi: 10.1016/s0140-6736(99)02744-0.
Tarr PE, Miele PS, Peregoy KS, Smith MA, Neva FA, et al. Case report: rectal adminstration of ivermectin to a patient with Strongyloides hyperinfection syndrome. Am J Trop Med Hyg. 2003;68(4):453-5. PMID: 12875295.
Barrett J, Broderick C, Soulsby H, Wade P, Newsholme W. Subcutaneous ivermectin use in the treatment of severe Strongyloides stercoralis infection: two case reports and a discussion of the literature. J Antimicrob Chemother. 2016;71(1):220-5. doi: 10.1093/jac/dkv315.
Bogoch II, Khan K, Abrams H, Nott C, Leung E, et al. Failure of ivermectin per rectum to achieve clinically meaningful serum levels in two cases of Strongyloides hyperinfection. Am J Trop Med Hyg. 2015;93(1):94-6. doi: 10.4269/ajtmh.15-0077.
Grein JD, Mathisen GE, Donovan S, Fleckenstein L. Serum ivermectin levels after enteral and subcutaneous administration for Strongyloides hyperinfection: a case report. Scand J Infect Dis. 2010;42(3):234-6. doi: 10.3109/00365540903443165.
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