Donor-Derived Strongyloides stercoralis Infection in Solid Organ Transplant Recipients in the United States, 2009–2013

Abstract

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.

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

“…Strongyloidiasis remains an underestimated public health problem . Donor‐derived Strongyloides infection has occurred after heart, kidney, kidney‐pancreas, and liver transplantation . Strongyloides transmission events have been documented in donors from Pennsylvania, New York, Nevada, Massachusetts, and Florida .…”

“…In the report of the CDC's experience with seven clusters of donor‐derived Strongyloides infection, the majority (86%) of the donors were born in Central or South America. Time from transplant to presentation ranges from 7 to 33 weeks …”

Late post‐kidney transplant Strongyloides hyperinfection syndrome

“…In organ transplant recipients, strongyloidiasis is usually reported within the first 3 months following transplantation, arising in recipients who were asymptomatically infected with S. stercoralis prior to transplant . Donor‐derived infections have also been reported, typically from donors who were current or previous residents of geographic locations with endemic Strongyloides . Late infections are uncommon.…”

Real-Time Polymerase Chain Reaction in Stool Detects Transmission of Strongyloides stercoralis from an Infected Donor to Solid Organ Transplant Recipients

“…Of note, no cases of infection occurred among those recipients who received an organ from infected donors, after receiving prophylaxis. 12 Transplant teams should be aware that strongyloidiasis is widely distributed in tropical and subtropical areas worldwide, 13 with higher transmission in regions with poorer socioeconomic conditions. Migrants from these regions are expected to present high infection rates such as in southeast Asia, where prevalence rates of up to 50% in the general population may be present.…”