Prevention of strongyloides hyperinfection syndrome: A rheumatological point of view |
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| Authors: | Mittermayer Santiago Bruno Leitão |
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| Affiliation: | 1. State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province 730046, PR China;2. College of Animal Science and Veterinary Medicine, Heilongjiang Bayi Agricultural University, Daqing, Heilongjiang Province 163319, PR China;3. Department of Parasitology, Heilongjiang Institute of Veterinary Science, Qiqihar, Heilongjiang Province 161006, PR China;1. Swiss Tropical and Public Health Institute, Basel, Switzerland;2. University of Basel, Basel, Switzerland;3. Department for Evolutionary Biology, Max-Planck-Institute for Developmental Biology, Tuebingen, Germany;4. National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia;5. Medical and Diagnostics Department, Swiss Tropical and Public Health Institute, Basel, Switzerland;1. Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;2. Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia;3. Institute of Ocean and Earth Sciences, University of Malaya, Kuala Lumpur, Malaysia;4. Institute of Parasitic Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang, PR China;5. Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand |
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| Abstract: | BackgroundStrongyloides stercoralis (S.stercoralis) is a parasite that infects humans and in conditions of immunodeficiency may disseminate, causing the potentially fatal strongyloides hyperinfection syndrome (SHS). The aim of this review was to investigate the literature evidence on the prophylaxis of SHS in immunosuppressed patients with rheumatological disorders.Material and methodsThe MEDLINE database (from 1966 to 2008) was searched using the following terms: “strongyloidiasis”, “disseminated strongyloidiasis”, “Strongyloides stercoralis”, “Strongyloides stercoralis dissemination”, “strongyloides hyperinfection syndrome”, “treatment”, “prophylaxis”, “prevention”, “immunocompromised”, “immunodepression”, “immunosuppressed”, “immunosuppression”, “corticosteroids”, “glucocorticoids”, “lupus erythematosus”, “rheumatoid arthritis”, “rheumatic diseases”. A search of the therapeutic studies using the same set of terms was carried out.ResultsNo study on the prophylaxis of SHS restricted to rheumatic immunosuppressed patients was identified. However, two articles have been published on the prophylaxis of strongyloidiasis in other immunosuppressed patients. Additionally, 13 studies dealing with different therapeutical options for strongyloidiasis were identified and presented.ConclusionsSince there is no evidence on the prophylaxis of SHS in immunosuppressed rheumatic patients, the suggested regimen for that prophylaxis may rely on the results obtained from therapeutical studies. Ivermectin has the best safety profile, lower cost and best efficacy and should be the drug of choice for the prophylaxis of SHS in such patients. Although a definitive prophylactic regimen has not been defined, the option for 200 µg/kg/day for 2 days, repeated within 2 weeks, seems to be a reasonable approach. Such regimen should be repeated every 6 months in case of persisting immunosuppression in permanent residents of endemic areas. |
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