Hyperinfection Strongyloidiasis: An Anticipated Outbreak in Kidney Transplant Recipients in Kuwait

Said, Tarek; Nampoory, M.R.N.; Nair, Muraleedharan G.; Halim, Medhat A; Shetty, Shama A.; Kumar, Avneesh; Mokadas, E.M.; El-Sayed, A; Johny, K.V.; Samhan, M; Al-Mousawi, M

doi:10.1016/j.transproceed.2007.03.047

Cited by 38 publications

(33 citation statements)

References 8 publications

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“…preferred in transplant patients as it is well tolerated and does not interact with immunosuppressant drugs (19). Table 2 lists the treatments used in previously reported cases of donor-derived strongyloidiasis (7)(8)(9)(10)(11)(12)(13)(14). While most reports describe parasite clearance within 21 days, clearance may take 30 days or longer with large parasite burden.…”

Section: Donor and Recipient Screeningmentioning

confidence: 99%

Single Donor-Derived Strongyloidiasis in Three Solid Organ Transplant Recipients: Case Series and Review of the Literature

Ravin

Hasan

et al. 2014

American Journal of Transplantation

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y Both authors have contributed equally to this work. Donor-derived Strongyloides stercoralis infections in transplant recipients are a rare but recognized complication. In this case series, we report donor-derived allograft transmission of Strongyloides in three solid organ transplant recipients. Following detection of infection in heart and kidney-pancreas recipients at two different transplant centers, a third recipient from the same donor was identified and diagnosed.S. stercoralis larvae were detected in duodenal aspirates, bronchial washings, cerebrospinal fluid, urine and stool specimens. Treatment with ivermectin and albendazole was successful in two of the three patients identified. The Centers for Disease Control and Prevention was contacted and performed an epidemiologic investigation. Donor serology was strongly positive for S. stercoralis antibodies on retrospective testing while all pretransplant recipient serum was negative. There should be a high index of suspicion for parasitic infection in transplant recipients and donors from endemic regions of the world. This case series underscores the need for expanded transplant screening protocols for Strongyloides. Positive serologic or stool tests should prompt early treatment or prophylaxis in donors and recipients as well as timely notification of organ procurement organizations and transplant centers.

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Section: Donor and Recipient Screeningmentioning

confidence: 99%

Single Donor-Derived Strongyloidiasis in Three Solid Organ Transplant Recipients: Case Series and Review of the Literature

Ravin

Hasan

et al. 2014

American Journal of Transplantation

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“…However, standard contact precautions appear to be sufficient to prevent nosocomial transmission [6]. Transmission of Strongyloides infection after transplantation of kidneys, pancreatic allograft, or intestines has been suggested in instances when donors but not recipients had a history of travel to a Strongyloides-endemic area [7][8][9].…”

Section: Epidemiologymentioning

confidence: 99%

Strongyloides stercoralis infection in the immunocompromised host

Ramanathan

Nutman²

2008

Curr Infect Dis Rep

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Strongyloides stercoralis is an intestinal nematode acquired in the tropics or subtropics. Most often, it causes chronic, asymptomatic infection, but a change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use is most commonly associated with hyperinfection syndrome. Diagnosis of Strongyloides infection is based on serology and serial stool examinations for larvae. The treatment of choice for chronic, asymptomatic infection is oral ivermectin. Alternative pharmacologic agents include albendazole and thiabendazole. For hyperinfection syndrome, ivermectin remains the drug of choice, though therapy duration must be individualized with the end point being complete parasite eradication. Recurrent strongyloidiasis should prompt an evaluation for human T-cell lymphotropic virus type 1 coinfection. No test of cure is currently available, although immunoglobulin G antibody levels have been shown to decline within 6 months of successful treatment.

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“…Prolonged corticosteroid use, either in the early post-transplant period or during treatment of rejection episodes, may reactivate dormant strongyloidiasis and promote its proliferation in infected hosts [28]. Cyclosporine may have protective effect [29,30] while tacrolimus increases the risk of infection. In a study in sprague-Dawley rats infected with strongyloides ratti, cyclosporine, given orally or subcutaneously, decreased the stool concentration of strongyloides by almost 50% and It neither synergized nor antagonized the effect of thiabendazole [31].…”

Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis infection in transplanted patients

2013

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Patient:Male, 36Final Diagnosis:StrongyloidiasisSymptoms:Abdominal pain • anorexia • eosinophilia • fever • letargy • weight lossMedication:—Clinical Procedure:—Specialty:Infectious diseasesObjective:Challenging differential diagnosis, rare diseaseBackground:Strongyloidiasis is a worldwide infection, infecting approximately 100 million people in more than 70 countries. It is common in Southeast Asia, Latin America, Papua New Guinea and some parts of the United States. Malnutrition, cancer, organ transplantation, hemodialysis and prolonged use of corticosteroids increase the risk of this opportunistic infection. Undiagnosed and untreated, its mortality rate can be high.Case Report:We present a 36 year old Black man with history of malignant hypertension and glomerulonephritis who had chronic eosinophilia and vague, poorly localized abdominal pain and tenderness. He received three deceased donor kidney transplants, two of them failed and the third one succeeded. However, after transplantation, his abdominal pain and discomfort increased, became anorexic, lost weight and developed fever and lethargy. Duodenal aspirate examination was positive for strongyloides stercoralis. Immunosuppressant medications were discontinued and he was treated with thiabendazole. In spite of treatment, his condition deteriorated and he expired.Conclusions:Due to low sensitivity of stool and serological examinations, diagnosis of strongyloidiasis often is delayed. A high index of suspicion and prompt diagnosis and treatment are essential in decreasing the morbidity and mortality of this infection. Before organ transplantation, every attempt should be made to find the cause of peripheral blood eosinophilia and in endemic areas and among patients coming from countries where the infection is known to exist, organ recipients and donors should be screened for parasitic infections including strongyloidiasis

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Hyperinfection Strongyloidiasis: An Anticipated Outbreak in Kidney Transplant Recipients in Kuwait

Cited by 38 publications

References 8 publications

Single Donor-Derived Strongyloidiasis in Three Solid Organ Transplant Recipients: Case Series and Review of the Literature

Single Donor-Derived Strongyloidiasis in Three Solid Organ Transplant Recipients: Case Series and Review of the Literature

Strongyloides stercoralis infection in the immunocompromised host

Strongyloides stercoralis infection in transplanted patients

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