A Reevaluation of the Tolerability and Effects of Single-Dose Ivermectin Treatment on Onchocerca volvulus Microfilariae in the Skin and Eyes in Eastern Ghana

Mass administration of ivermectin (IVM) has significantly reduced onchocerciasis prevalence, intensity, and morbidity in most endemic areas. Most IVM clinical trials were performed long ago in persons with high-intensity infections that are uncommon in West Africa today. This cohort treatment study recruited participants from a hypoendemic area in eastern Ghana to reevaluate the efficacy and tolerability of IVM with a special focus on the kinetics of microfilaria (Mf) clearance. Mf in the skin and anterior chambers (ACs) were assessed by skin snip and slit lamp examinations at baseline and at 3 and 6 months after treatment with IVM 150 μg/kg. Out of 231 people, 79 enrolled were treatment-naïve. The baseline geometric mean skin Mf count was 12.67/mg (range 3–86). Although persons with MfAC at baseline (64/231, 27%) had significantly higher skin Mf counts than people without MfAC, 7 of 39 (15%) of persons with skin Mf counts in the range of 3–5 Mf/mg had MfAC. Skin Mf were detected in 14% (31/218) and 45% (96/216) of participants 3 and 6 months after IVM treatment, respectively. MfAC were detected in 12 of 212 (5.7%) study participants at 6 months 81% (187 of 231) of participants experienced 439 adverse events within 7 days after treatment; all adverse events were mild (96.1%) or moderate. This study has provided new data on the kinetics of Mf in the skin and eyes after IVM treatment of persons with light to moderate intensity Onchocerca volvulus infections that are common in Africa at this time.

An Integrated District Mapping Strategy for Loiasis to Enable Safe Mass Treatment for Onchocerciasis in Gabon

The lack of a WHO-recommended strategy for onchocerciasis treatment with ivermectin in hypo-endemic areas co-endemic with loiasis is an impediment to global onchocerciasis elimination. New loiasis diagnostics (LoaScope; Loa antibody rapid test) and risk prediction tools may enable safe mass treatment decisions in co-endemic areas. In 2017–2018, an integrated mapping strategy for onchocerciasis, lymphatic filariasis (LF), and loiasis, aimed at enabling safe ivermectin treatment decisions, was piloted in Gabon. Three ivermectin-naïve departments suspected to be hypo-endemic were selected and up to 100 adults per village across 30 villages in each of the three departments underwent testing for indicators of onchocerciasis, LF, and loiasis. An additional 67 communities in five adjoining departments were tested for loiasis to extend the prevalence and intensity predictions and possibly expand the boundaries of areas deemed safe for ivermectin treatment. Integrated testing in the three departments revealed within-department heterogeneity for all the three diseases, highlighting the value of a mapping approach that relies on cluster-based sampling rather than sentinel sites. These results suggest that safe mass treatment of onchocerciasis may be possible at the subdepartment level, even in departments where loiasis is present. Beyond valuable epidemiologic data, the study generated insight into the performance of various diagnostics and the feasibility of an integrated mapping approach utilizing new diagnostic and modeling tools. Further research should explore how programs can combine these diagnostic and risk prediction tools into a feasible programmatic strategy to enable safe treatment decisions where loiasis and onchocerciasis are co-endemic.

ROLE OF IVERMECTIN IN THE TREATMENT OF COVID 19

In vitro, ivermectin, an anti-parasitic drug licenced by the US Food and Drug Administration, was found to limit the replication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).The three groups had similar clinical symptoms of fever, cough, and sore throat. When compared to the placebo group, virological clearance was faster in the 5-day ivermectin treatment arm (9.7 days vs 12.7 days p = 0.02), but not in the ivermectin Plus doxycycline arm (11.5 days p = 0.27). In the research, there were no serious adverse medication reactions. Adult patients with mild COVID-19 were treated with a 5-day course of ivermectin, which was proven to be both safe and efficacious. To corroborate these early findings, larger trials will be required.

Risk Factors for New Zealand Sea Lion (Phocarctos hookeri) Pup Mortality: Ivermectin Improves Survival for Conservation Management

Septicaemia due to hypervirulent (HV) Klebsiella pneumoniae is the leading cause of neonatal pup mortality in endangered New Zealand sea lions (Phocarctos hookeri) at Enderby Island, in the New Zealand sub-Antarctic. Accounting for approximately 60% of annual pup mortality at this site following an epizootic event in 2001–02, HV K. pneumoniae is also emerging worldwide as a significant community-acquired human pathogen. To facilitate efficient direct mitigation to reduce pup mortality, a case-control study and prospective cohort study were conducted to identify risk factors amenable to active management. Additionally, to investigate impacts of hookworm (Uncinaria spp.), a nested treatment trial with the anthelmintic ivermectin was undertaken concurrently. During two austral summer field seasons (2016–2018), 698 pups were captured for treatment trial recruitment and the collection of morphometric measurements, biological samples and risk factor data. Gastrointestinal carriage of the virulent phenotype of K. pneumoniae was a consistent risk factor, while ivermectin treatment and higher body condition index consistently reduced risk of HV K. pneumoniae mortality. Significantly fewer ivermectin-treated pups were found dead (24.1% control, 11.1% treatment), with a trend towards a higher proportion of HV K. pneumoniae deaths amongst the control group. This study provides evidence to support ivermectin treatment as a pup mortality mitigation strategy in New Zealand sea lions at Enderby Island. If applied to larger colonies where HV K. pneumoniae and hookworm impact pup survival, this intervention could have population-scale benefits for this endangered species. Further work is required to understand how ivermectin prevents HV K. pneumoniae septicaemia, but removal of hookworms before intestinal mucosal damage occurs could limit systemic spread of virulent bacteria from the gastrointestinal tract.

Ivermectin treatment for Strongyloides infection in patients with COVID-19

Ivermectin, an antiparasitic agent, is not recommended for prophylaxis or treatment of coronavirus disease 2019 (COVID-19). Inappropriate use of ivermectin for treatment of COVID-19 may make it less available for patients with serious parasitic infections who could benefit from its use and worsen the current shortage of ivermectin in Canada. However, patients with COVID-19 who are candidates to receive immunomodulatory therapies (e.g. corticosteroids and interleukin-6 inhibitors) may be at risk of hyperinfection syndrome and disseminated disease from Strongyloides stercoralis. These complications can be severe and even fatal. It is important to recognize and screen patients who may be at risk of strongyloidiasis, as these patients may require treatment with ivermectin to avoid the potential for a hyperinfection syndrome and disseminated disease, which is frequently deadly. Clinicians should follow evidence-based recommendations to screen and treat for Strongyloides infection in patients with COVID-19 who are under consideration to receive specific COVID-19 therapies that alter immune response and may lead to hyperinfection syndrome or disseminated disease.

Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol

Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.

Update on COVID-19 Infection and Ivermectin Treatment

Coronaviruses are a group of related RNA viruses that cause disease in mammals and birds. COVID-19 infection is caused by a single stranded RNA virus called SARS-CoV-2 that is similar to the severe acute respiratory syndrome coronavirus (SARS-CoV). The aim of this review is to identify how COVID-19 infects man, the preventive approach and treatment possibility with ivermectin drug. The possible main source of transmission is thought to be a close contact with infected person or animal and respiratory droplets while the mucous membrane; conjunctiva, mouth, nasal cavity, and throat are the main routes of transmission. The virus enters the human through the ACE2 receptor which are found in the mucous membrane. This is an important step for coronavirus infection establishment. To stay safe from coronavirus, physical distancing, wearing of face mask, keeping rooms well ventilated, avoiding crowds, cleaning/washing your hands, the use of hand sanitizers and coughing into a bent elbow are precautionary measures to avoid contracting the infection. Ivemectin blocks the initiation of the binding of the viral protein to the cytoplasmic receptor (imp α/β). The inhibitory role of ivemectin prevents further increase in the viral load. Ivermectin drug could be a remarkable medical breakthrough for the lasting treatment of the infection; however, more clinical trials are suggested in this area.