Strongyloides hyperinfection syndrome after intestinal transplantation

Abstract

Strongyloides stercoralis is a helminth with the ability to autoinfect the human host and persist asymptomatically for several years. Immunosuppression can accelerate autoinfection and result in Strongyloides hyperinfection syndrome (SHS), which is associated with significant morbidity and mortality. Immunosuppressed solid organ transplant recipients, particularly in the setting of rejection, are at increased risk for reactivation of latent infections, such as Strongyloides. We describe a case of SHS in an intestinal transplant recipient; we hypothesize that she acquired the infection from the donor. We also review the current literature and address both prophylaxis and treatment of strongyloidiasis in the solid organ transplant patient.

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

“…In the case reports reviewed, seven patients were successfully treated while five succumbed to Strongyloides or related complications. Donor-derived infection was confirmed by serologic testing in only six reported cases (7)(8)(9)(10)(11)(12)(13)(14). Symptoms generally present within 6 weeks, but have been reported up to 9 months posttransplantation.…”

“…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.…”

Strongyloides stercoralis infection in the immunocompromised host

“…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].…”

Donor-Derived Infectious Complications and Disease Transmission

“…Strongyloidiasis, which has mainly been described in kidney transplant recipients, has been considered in most cases to be caused by reactivation of a latent infection (Hoy et al, 1981). More recently, a few cases have been documented in pancreatic and intestine transplant recipients and were attributed to transmission from the donated organs (Ben-Youssef et al, 2005;Patel et al, 2008). The clinical disease may present with pulmonary involvement, sepsis, meningitis with multiple gram-negative rods, and acute and severe abdominal disease, including ileus and intestinal obstruction, and gastrointestinal hemorrhage.…”

“…Strongyloidiasis can be a devastating disease in transplant recipients despite therapy. The mortality rate approaches 50-70% in recipients with hyperinfection syndrome and disseminated infection (Patel et al, 2008).…”