Post-Renal Transplant Miliary Mottling: Not Always Tuberculosis

Raj, T Yashwanth; Vairakkani, R; Harshavardhan, T S; Srinivasaprasad, ND; Rani, V Dilli; Fernando, M Edwin

doi:10.4103/ijn.ijn_141_19

Cited by 2 publications

(7 citation statements)

References 10 publications

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“…The majority of strongyloidiasis cases (70/93, [75.3%]) were reported among kidney transplant (KT) recipients (68/91[74.7%]), 9 , 10 , 12 , 13 , 15 , 17 , 18 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 30 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 49 , 51 , 52 , 53 , 54 , 56 , 57 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 67 , 68 , 69 , 70 , 72 , 73 , 74 , 75 , 76 , 77 , 78 ...…”

Section: Resultsmentioning

confidence: 99%

A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation

Abad

Bhaimia

Schuetz

et al. 2022

Clinical Transplantation

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Background:We reviewed the scientific literature to gain insight on the epidemiology and outcome of Strongyloides stercoralis infections after transplantation. Methods: CINAHL, PUBMED, and OVID/MEDLINE were reviewed from inception through March 31, 2022 using key words Strongyloides and transplantation. Results: Our review identified 108 episodes of Strongyloides infection among 91 solid organ transplant (SOT) and 15 hematopoietic cell transplant (HCT) recipients. Median time to infection was 10.8 (range, .14-417) and 8.8 (range, 0-208) weeks after SOT and HCT, respectively. Gastrointestinal symptoms were frequent (86/108 [79.6%]), while skin rash (22/108 [20.3%]) and fever (31/103 [30%]) were less common. Peripheral eosinophilia was observed in half of patients (41/77 [53.2%]). Bacteremia (31/59 [52.5%]) was frequently due to Gram-negative organisms (24/31 [77.4%]). Abnormal chest radiologic findings were reported in half (56/108 [51.9%]). The majority had hyperinfection syndrome (97/108 [89.8%]) while disseminated strongyloidiasis was less common (11/108 [10.2%]). Thirty-two cases were categorized as donorderived infection (DDI), with donors (23/24 [95.8%]) who had traveled to or lived in endemic areas. Median time to DDI was 8 weeks (range .5-34.3 weeks) after transplantation. Treatment consisted of ivermectin (n = 26), a benzimidazole (n = 27), or both drugs (n = 28). There was high all-cause mortality (48/107, 44.9%) and a high Strongyloides-attributable mortality (32/49, 65.3%).Conclusions: Strongyloidiasis should be strongly considered among recipients with epidemiologic risk factors for infection, even in the absence of eosinophilia or rash. A policy that provides guidance on pro-active screening is needed, to ensure preventive measures are provided to recipients at increased risk.

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Section: Resultsmentioning

confidence: 99%

A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation

Abad

Bhaimia

Schuetz

et al. 2022

Clinical Transplantation

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“…The 20 manuscripts included were all in the editorial form of case reports [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], barring the retrospective analysis by Miglioli-Galvão and colleagues [ 30 ], and 31 patients were included. The paper by Miglioli-Galvão et al did not include clinical and microbiological data of the patients (n = 10), and for this reason it was excluded from the final analysis presented in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Most of the cases presented in this review occurred in males [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Females, in fact, comprised one third of the total cases reviewed, and the median age in women was 59 (46–66) years [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Interestingly, Arakaki and colleagues [ 31 ] compared high-endemic groups and lower-endemic groups in Okinawa (Japan), showing that patients were older at the time of Strongyloides diagnosis in a setting with lower prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…We report a higher incidence of Strongyloides /CMV co-infection in renal transplants [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. It is not possible to determine the precise incidence of infection caused by Strongyloides after solid organ transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature

et al. 2023

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Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37–59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.

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Post-Renal Transplant Miliary Mottling: Not Always Tuberculosis

Cited by 2 publications

References 10 publications

A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation

A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation

Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature

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