Complications
Giving ivermectin to people originating from African countries who have a concomitant heavy infection with Loa loa filariasis (African eyeworm) may result in the development of a fever and encephalitis due to the mass killing of Loa loa microfilariae.
The risk is <1% in very high burden areas, and typically occurs in those with >30,000 microfilariae/mL blood.[29][28][30]
People considered to be at risk are from Cameroon, Gabon, Congo, Republic of the Congo, Equatorial Guinea, South Sudan, Central African Republic, Chad, Angola, and Nigeria.[27]
People at risk first require screening by Giemsa-stained blood smear for filariasis, collected during the daytime (10 a.m. to 2 p.m.), before receiving ivermectin.[27][28]
Albendazole has a 20% to 30% greater rate of treatment failure than ivermectin.[33][39][40][42][43][44][45]
All larvae need to be eradicated otherwise auto-infection will continue the strongyloides infection indefinitely.
A total of 65% to 80% of people treated with 2 doses of ivermectin will either revert to a negative serology after 6 months or have a 40% decrease in the quantitative measurement.[52] An increase in serology prompts concerns for treatment failure.
This occurs with an immunosuppressive condition or corticosteroid therapy.
Mortality rate among patients who develop hyperinfection syndrome or disseminated strongyloidiasis may be as high as 90%.[48] Absence of eosinophilia at presentation is a marker for >85% risk of mortality.[20][21]
Carries a high risk of gram-negative septicaemia so usually requires broad-spectrum antibiotics.[1]
Use of this content is subject to our disclaimer