Active Ingredients: Ivermectin
Anyone currently receiving cyclosporin, cyclophosphamide, azathioprine, mycophenolate, tacrolimus or cancer chemotherapy. It does not include the following patients: inhaled corticosteroids, hydroxychloroquine, sulfasalazine, colchicine, gold, weekly methotrexate and oral courses of prednisone less than 14 days regardless of dose and where the frequency is less than six courses per year.
The rate of infection was not increased in patients receiving less than 10 mg per day or a cumulative dose of less than 700 mg of prednisone which is roughly equivalent to 0.
This is supported by there having been to date no confirmed cases of disseminated strongyloidiasis in the Top End in patients on intermittent prednisolone therapy for respiratory and other conditions.
Each infection will be addressed in turn. Top of page Strongyloides stercoralis Strongyloides infestation is endemic in most remote communities of the Top End of the Northern Territory, particularly in the East Arnhem region. Reliable prevalence data for other Top End communities is not available, but the incidence of symptomatic infection and stool positivity seems significantly lower outside East Arnhem.
We encourage collection and analysis of stool prevalence data from Northern Territory communities outside East Arnhem to confirm this impression. The reported mortality of DS is up to 87 per cent.
Eosinophilia is usually absent in immunosuppressed people with strongyloides hyperinfestation, although it is often present before immunosuppression begins. In a 1993 RDH survey, peripheral eosinophilia was only present in 57 per cent of immunocompetent patients with asymptomatic infection.
Culture of stool as opposed to direct microscopic examination improves sensitivity, but is labour intensive, and poses a small risk of laboratory-acquired infection.
Agar-plate culture of a single stool specimen was approximately 90 per cent sensitive in one study. The utility of serology varies widely depending on the exact nature of the test used.
Performance can be enhanced by pre-incubating the patient's serum with Onchocerca antigens to eliminate non-specific cross-reactions before testing.
The titre does not reliably fall with successful eradication. Top of page In summary the sensitivity of current diagnostic methods is not sufficiently high to be able to confidently exclude chronic asymptomatic infestation in a patient who is about to begin immunosuppression.