Table of Contents Author Guidelines Submit a Manuscript
Journal of Parasitology Research
Volume 2009, Article ID 818296, 4 pages
http://dx.doi.org/10.1155/2009/818296
Case Report

Fatal Outcome of Disseminated Strongyloidiasis despite Detectable Plasma and Cerebrospinal Levels of Orally Administered Ivermectin

1Lexington Infectious Disease Consultants, Lexington, KY 40503, USA
2Department of Pharmacy, University of Kentucky, Lexington, KY 40504, USA
3Commonwealth Neurology, Lexington, KY 40503, USA
4University of Iowa College of Pharmacy, Iowa City, IA 52242, USA

Received 15 December 2008; Accepted 6 February 2009

Academic Editor: Domenico Otranto

Copyright © 2009 Charles E. Rose III et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Strongyloides stercoralis affects over 100 million people worldwide. Those people most susceptible to infection are those with an immunocompromising condition, such as cancer or human immunodeficiency virus (HIV). Local disease may spread throughout the body of the host, causing a condition termed disseminated strongyloidiasis. Standard treatment for Strongyloides stercoralis infection is oral ivermectin. We describe a patient with chronic lymphocytic leukemia diagnosed with disseminated strongyloidiasis two weeks after initial presentation. After repeated dosing of oral ivermectin with no clinical response, serum and cerebral spinal fluid (CSF) concentrations of ivermectin were measured to assess absorption. The peak serum concentration of 49.3 ng/mL correlated with a CSF concentration of 0.14 ng/mL. Despite these concentrations, the patient eventually succumbed to multi-system organ failure. We discuss the reasons for treatment failure and explore the utility of measuring ivermectin concentrations.