Tratamento farmacológico da estrongiloidíase em pacientes transplantados / Pharmacological treatment of strongilloidiasis in transplanted patients

O objetivo deste artigo foi comparar o uso da ivermectina e do albendazol em pacientes transplantados e relatar os respectivos sucessos terapêuticos nessa população. Foram analisados artigos que abordassem relatos de casos publicados nos últimos 4 anos no PubMed® relacionando os descritores "transplante de órgãos", "estrongiloidíase" e "tratamento". Foram encontrados e analisados dez relatos de caso que abordaram a estrongiloidíase em situa- ção pós-transplante contemplando 13 indivíduos. Desses, cinco (38,5%) utilizaram ambos os medicamentos, dos quais quatro (80%) se curaram, tendo recebido albendazol e ivermectina por via subcutânea (50%) ou albendazol e ivermectina por vias oral/ subcutânea (50%). O paciente que morreu recebeu albendazol e ivermectina por via subcutânea. Sete (53,8%) indivíduos utiliza- ram apenas ivermectina, dos quais três (42,8%) se curaram tendo recebido o medicamento oral (dois pacientes) ou subcutâneo (um paciente); dois (28,6%) morreram recebendo o medicamento via oral, dois (28,6%) usaram profilaticamente via oral e apenas um não manifestou sintomas. Apenas um (7,7%) indivíduo utilizou somente albendazol via oral tendo sobrevivido à infecção. A uti- lização combinada dos medicamentos ivermectina e albendazol parece ter efeito positivo no tratamento da estrongiloidíase. A administração da ivermectina por via subcutânea apresentou resultados promissores, contudo estudos controlados de siner- gia medicamentosa e vias de administração devem ser realizados para efetiva avaliação.

The objective of this article was to compare the use of ivermec- tin and albendazole in transplanted patients and to report the respective therapeutic successes in this population.Articles ad- dressing case reports published in the last 4 years in the PubMed relating the descriptors "organ transplantation", "strongyloidia- sis", and "treatment" were analyzed. Ten case reports addres- sing strongyloidiasis in a post-transplant situation, covering 13 individuals, were found and analyzed. Of these, five (38.5%) used both drugs of which 4 (80%) were cured having received subcu- taneous albendazole and ivermectin (50%) or oral/subcutaneous albendazole and ivermectin (50%). The patient who died received subcutaneous albenzadole and ivermectin. Seven (53.8%) indi- viduals used only ivermectin, of which three (42.8%) were cured having received the oral (2/3) or subcutaneous (1/3) medication, two (28.6%) died receiving the oral medication, and two (28.6%) used oral medication prophylactically, and only one did not show symptoms. Only one (7.7%) individual used only oral albenzadole and survived the infection. The combined use of the drugs iver- mectin and albendazole seems to have a positive effect on the treatment of strongyloidiasis. The administration of subcuta- neous Ivermectin has shown promising results; however, con- trolled studies of drug synergy and administration routes shall be performed for effective evaluation.

Clinical profile, diagnostic challenge and management of alveolar hydatid disease: a prospective study

Background: Although a rare entity, alveolar hydatid disease is associated with significant morbidity. This disease presents a diagnostic challenge because of its low prevalence, unfamiliarity and nonspecific presentation. Aim: To look about the clinical profile, diagnosis and management of these patients.Methods: This prospective study was conducted in the department of surgery at SMHS (Shri Maharaja Harisingh) hospital. All patients with a diagnosis of alveolar hydatid disease of liver during this time period were enrolled in the study.Results: Eight patients in our study were females and 5 patients were males. The age ranged from 21 to 56 years with mean age of 42.07±8.88 years (SD =8.88). The most common presentation in our study was pain abdomen (38%). The most common finding on physical examination was hepatomegaly (30.76%). CT (computerized tomography) scan abdomen gave an impression of alveolar hydatid disease in 5 patients, a suspicion of malignancy in 3 patients and tuberculosis in one patient, and a possibility of liver abscess in one patient. Results of tru cut biopsy were suggestive of alveolar hydatid disease in 4 out of 6 patients. Twelve patients were operated on elective basis (liver radical resection in 8 patients, while “laparotomy and only tumor biopsy” in 4 unresectable patients) and one patient on emergency basis, and all were subjected to histopathological examination. ABZ (albendazole) was given orally at a dosage of 10-15 mg/kg per day.Conclusions: Alveolar hydatid is a rare disease with atypical (unfamiliar) and nonspecific clinical features and atypical radiological features. Also, the disease is associated with significant morbidity, hence a high index of suspicion is needed along with supplementary imaging studies for timely intervention to prevent further complications arising from the disease.