Expanded infectious diseases screening program for Hispanic transplant candidates

Abstract

Most guidelines for pre-transplant screening recommend enhanced screening among patients with potential exposure to such pathogens as Strongyloides stercoralis and Trypanosoma cruzi, the cause of Chagas disease. The incidence of these diseases in the Hispanic immigrant population has not been extensively studied. Transplant candidates who were evaluated by our program's Hispanic Transplant Program were referred for expanded infectious disease screening including Mycobacterium tuberculosis, S. stercoralis, Leishmania, and T. cruzi. Between December 2006 and December 2008, 83 patients were screened. Most were from Mexico but we also screened patients from Ecuador, Puerto Rico, and Peru. Most patients lived in urban locations before moving to the United States. Latent tuberculosis infection (LTBI) was found in 20%, and 6.7% had serologic evidence of S. stercoralis infection. These patients underwent treatment of latent infection without difficulty. To date, 14 patients have undergone living-donor kidney transplantation. Two of these patients had positive Leishmania titers and are being followed clinically, 1 was treated for S. stercoralis, and 2 were treated for LTBI pre-transplant. All have done well without evidence of screened pathogens an average of 348 days (range 65-766 days) post transplant. Expanded screening identifies endemic infections in the Hispanic immigrant population that can be treated before transplant, thereby minimizing post-transplant infectious complications.

Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries

“…Screening for Strongyloides stercoralis and treatment of seropositive patients have been instituted to avoid the hyperinfection syndrome [80]. Some centers also screen for trypanosomiasis and leishmaniasis although the rate of adverse outcomes associated with these infections after immunosuppression for ALL is unknown.…”

“…The potential for parasite reactivation during immunosuppression has led to expanded screening programs for at-risk patients [80]. Screening for Strongyloides stercoralis and treatment of seropositive patients have been instituted to avoid the hyperinfection syndrome [80].…”

Mechanisms of cellular invasion by intracellular parasites

“…The mechanisms by which T. cruzi life cycle forms invade human cells are discussed in more detail below. While insect transmission is the primary mode of parasite acquisition, oral and transplacental routes can also occur and infection through transplanted blood and tissue from chronically infected individuals is increasing worldwide and has prompted expansion of screening practices of donated products[96, 97]. …”

New challenges in the epidemiology and treatment of visceral leishmaniasis in periurban areas

“…Fitzpatrick et al [2010] described an expanded pre-transplant infectious diseases screening program that includes Leishmania antibody tests with clinical follow up for patients with positive antibody results and over two years, they detected two patients with positive Leishmania serology pre-transplant. The guidelines of the American Society of Transplantation Infectious Diseases Community of Practice for parasitic infections in solid organ transplant patients were published in 2009 [Kotton and Lattes, 2009].…”