Volume 79, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


A man with meningitis and bacteremia, while on dexamethasone, developed hyperinfection syndrome and died despite salvage therapy with subcutaneous ivermectin. We report the first documented total and free levels of subcutaneous ivermectin used for therapy.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Siddiqui AA, Genta RM, Berk SL, 2006. Strongyloidiasis. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases–Principles, Pathogens and Practice. (Second edition). Philadelphia: Churchill Livingstone, 1274.
  2. Gyorkos TW, Genta RM, Viens P, MacLean JD, 1990. Sero-epidemiology of Strongyloides infection in the southeast Asian refugee population in Canada. Am J Epidemiol 132 : 257–264. [Google Scholar]
  3. Keiser PB, Nutman TB, 2004. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 17 : 208–217. [Google Scholar]
  4. Pacanowski J, Santos MD, Roux A, Maignan C, Guillot J, Lavarde V, Cornet M, 2005. Subcutaneous ivermectin as a safe salvage therapy in Strongyloides stercoralis hyperinfection syndrome: a case report. Am J Trop Med Hyg 73 : 122–124. [Google Scholar]
  5. Turner SA, Maclean JD, Fleckenstein L, Greenaway C, 2005. Parenteral administration of ivermectin in a patient with disseminated strongyloidiasis. Am J Trop Med Hyg 73 : 911–914. [Google Scholar]
  6. Marty FM, Lowry CM, Rodriguez M, Milner DA, Pieciak WS, Sinha A, Fleckenstein L, Baden LR, 2005. Treatment of human disseminated strongyloidiasis with a parenteral veterinary formulation of ivermectin. Clin Infect Dis 41 : e5–e8. [Google Scholar]
  7. Hauber HP, Galle J, Chiodini PL, Rupp J, Birke R, Vollmer E, Zebel P, Lange C, 2005. Fatal outcome of a hyperinfection syndrome despite successful eradication of Strongyloides with subcutaneous ivermectin. Infection 33 : 383–386. [Google Scholar]
  8. Salluh JI, Feres GA, Velasco E, Holanda GS, Toscano L, Soares M, 2005. Successful use of parenteral ivermectin in an immunosuppressed patient with disseminated strongyloidiasis and septic shock. Intensive Care Med 31 : 1292. [Google Scholar]
  9. Chiodini PL, Reid AJ, Wiselka MJ, Firmin R, Foweraker J, 2000. Parenteral ivermectin in Strongyloides hyperinfection. Lancet 355 : 43–44. [Google Scholar]
  10. Kitzman D, Wei SY, Fleckenstein L, 2006. Liquid chromatographic assay of ivermectin in human plasma for application to clinical pharmacokinetic studies. J Pharm Biomed Anal 40 : 1013–1020. [Google Scholar]
  11. Barber S, Bowles V, Lespine A, Alvinerie M, 2003. The comparative serum disposition kinetics of subcutaneous administration of doramectin, ivermectin and moxidectin in the Australian Merino sheep. J Vet Pharmacol Ther 26 : 343–348. [Google Scholar]
  12. Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ 171 : 479–484. [Google Scholar]
  13. Takayanagui OM, Lofrano MM, Araujo MB, Chimelli L, 1995. Detection of Strongyloides stercoralis in the cerebrospinal fluid of a patient with acquired immunodeficiency syndrome. Neurology 45 : 193–194. [Google Scholar]
  14. Thomas MC, Costello SA, 1998. Disseminated strongyloidiasis arising from a single dose of dexamethasone before stereotactic radiosurgery. Int J Clin Pract 21 : 520–521. [Google Scholar]
  15. Boken DJ, Leoni PA, Preheim LC, 1992. Treatment of Strongyloides stercoralis hyperinfection syndrome with thiabendazole administered per rectum. Clin Infect Dis 16 : 123–126. [Google Scholar]
  16. Kennedy S, Campbell RM, Lawrence JF, Nichol GM, Rao DM, 1989. A case of severe Strongyloides stercoralis infection with jejunal perforation in an Australian ex-prisoner of war. Med J Aust 150 : 92–93. [Google Scholar]
  17. Tarr PE, Miele PS, Peregoy KS, Smith MA, Neva FA, Lucey DR, 2003. Case report: rectal administration of ivermectin to a patient with Strongyloides hyperinfection syndrome. Am J Trop Med Hyg 68 : 453–455. [Google Scholar]
  18. Lifschitz A, Virkel G, Pis A, Imperiale F, Sanchez S, Alvarez L, 1999. Ivermectin disposition kinetics after subcutaneous and intramuscular administration of an oil-based formulation to cattle. Vet Parasitol 86 : 203–215. [Google Scholar]
  19. Klotz U, Ogbuokiri JE, Okonkwo PO, 1990. Ivermectin binds avidly to plasma proteins. Eur J Clin Pharmacol 39 : 607–608. [Google Scholar]
  20. Okonkwo PO, Ogbuokiri JE, Ofoegbu E, Klotz U, 1993. Protein binding and ivermectin estimations in patients with onchocerciasis. Clin Pharmacol Ther 53 : 426–430. [Google Scholar]
  21. Satou T, Koga M, Koike K, Tada I, Nikaido T, 2001. Nematocidal activities of thiabendazole and ivermectin against the larvae of Strongyloides ratti and S. venezuelensis. Vet Parasitol 99 : 311–322. [Google Scholar]
  22. Kotze AC, Clifford S, O’ Grady J, Behnke JM, McCarthy JS, 2004. An in vitro larval motility assay to determine anthelmintic sensitivity for human hookworm and Strongyloides species. Am J Trop Med Hyg 71 : 608–616. [Google Scholar]

Data & Media loading...

  • Received : 23 Jul 2008
  • Accepted : 17 Sep 2008

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error