Strongyloidiasis prophylaxis: Ivermectin in neurological patients undergoing immunosuppressive treatment

Introduction: Strogyloides stercolaris is a nematode that after infection can remain in asymptomatic form for decades. Autoimmune neurological disorders with  impairment of Th2 cell-mediated immunity or involving the use of immunosuppressive and immunomodulatory drugs might predispose patients to the hyperinfection syndrome and disseminated disease caused by strongyloidiasis, related to a high mortality rate. Therefore, a prophylactic treatment with ivermectin has been suggested for patients from endemic regions undergoing immunosuppressive treatment.

Objectives: We aim to analyze if Ivermectin should be recommended in autoimmune neurological disorders hosts undergoing immunosuppressive treatment.

Methods:  This abstract is a non-systematic review. All articles used were searched in PubMed and Google Scholar. We selected the most relevant articles available in English or Portuguese. Terms used in the research were related to: neuroimmunological patients, strongyloidiasis, immunosuppressive drugs, ivermectin.

Results: Ivermectin as a prophylactic treatment did not demonstrate evidence of efficacy in neurological patients with deficient cellular immunity or under an immunosuppressive therapeutic regimen. A study exposes the hypothesis that anti-parasitic medication might cause depletion of intestinal microbes that contribute to immune tolerance, which could result in a greater predisposition to neurological inflammatory disorders, such as multiple sclerosis. Current evidence indicates that ivermectin's effectiveness is mainly limited to confirmed cases of strongyloidiasis or suspected infections, rather than as a prophylactic measure.

Conclusion: There are currently no studies and evidence to assess the effectiveness and side effects of the use of ivermectin as a prophylactic treatment for strongyloidiasis in immunosuppressed neurological patients. It is shown necessary to conduct more studies such as clinical trials to estimate its real effectiveness and the possible associated unwanted effects.