Active Ingredient: Ivermectin
Similar reductions were seen in the baseline cohort and new entrants.
We demonstrated a sustained reduction in Strongyloides seroprevalence following the ivermectin MDA. Introduction Strongyloides is a neglected tropical disease which infects an estimated 100 million people worldwide. There is however, a strong emphasis on preventing disseminated strongyloidiasis by use of pre-emptive ivermectin therapy for immunosuppressed individuals from remote Indigenous communities where Strongyloides is endemic.The infections discussed are Strongyloides stercoralis, tuberculosis, scabies, chronic hepatitis B, melioidosis and other bacterial infections.
Our aim was to determine if MDA was an effective public health measure to reduce the prevalence of both endemic infections. Study design Following consultation with residents from a remote island community we designed a staged roll-out of two population census and MDAs delivered 12 months apart.
In a study at the RDH renal unit of patients undergoing renal replacement therapy, 73 of 122 Indigenous patients 59.
This would include cyclophosphamide, azathioprine, cyclosporin, mycophenolate and leflunomide but not corticosteroids alone. Assessment will usually include a liver biopsy and initiation of lamivudine and possibly regular hepatitis B immunoglobulin.
The other and most newly available antiviral treatment is adefovir dipivoxyl. At this stage, adefovir remains reserved for use in those developing the YMDD lamivudine resistant mutation of the reverse transcriptase gene, which occurs commonly e.
Management recommendations to prevent reactivation of hepatitis B in eligible patients —Any HBsAg positive patient in whom chemotherapy for cancer or potent immunosuppression is planned should be referred to the liver clinic for assessment, preferably prior to therapy.
There have been cases of both acute melioidosis and relapsed melioidosis in people on therapeutic immunosuppression,29 and thus it is probable that all significant therapeutic immunosuppression increases the probability of melioidosis occurring, and of it being more severe if it does occur.
Nocardia infection is uncommon, but well described in immunosuppressed people. Pulmonary and cerebral infections are likely to occur if an immunosuppressed person is infected, and are difficult to treat and have a high mortality.