Infection with Strongyloides stercoralis is typically
asymptomatic in immunocompetent hosts, despite chronic infection. In contrast,
immunocompromised hosts such as solid organ transplant recipients are at risk
for hyperinfection syndrome and/or disseminated disease, frequently resulting in
fatal outcomes. Infection in these recipients may result from reactivation of
latent infection or infection through transmission from an infected donor. We
describe the Centers for Disease Control and Prevention's experience
with seven clusters of donor-derived infection from 2009 to 2013. Six of the
seven (86%) donors were born in Latin America; donor screening was not
performed prior to organ transplantation in any of these investigations. Eleven
of the 20 (55%) organ recipients were symptomatic, two of whom died from
complications of strongyloidiasis. We also describe the New York Organ Donor
Network (NYODN) experience with targeted donor screening from 2010 to 2013. Of
the 233 consented potential donors tested, 10 tested positive for
Strongyloides antibody; and 18 organs were transplanted.
The majority (86%) of the donors were born in Central or South America.
Fourteen recipients received prophylaxis after transplantation; no recipients
developed strongyloidiasis. The NYODN experience provides evidence that when
targeted donor screening is performed prior to transplantation, donor-derived
infection can be averted in recipients.
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