Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Abstract

Strongyloides stercoralis is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for Strongyloides stercoralis hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for Strongyloides stercoralis seropositivity by established ELISA testing. Positive Strongyloides stercoralis serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as Strongyloides infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some Strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not.

High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study

“…However, few programs have reported their results so far. In this regard, a reference center in Austria has initiated the screening of S. stercoralis for all transplant recipients showing a 3% prevalence even though only a small percentage are migrants and most of them are from East European countries [28].…”

Characterization of a non-sexual population of Strongyloides stercoralis with hybrid 18S rDNA haplotypes in Guangxi, Southern China

“…However, the presence of S . stercoralis and strongyloidiasis, including fatal cases, have also been reported from well-developed regions with temperate climates such as the European Union and North America [8–15].…”

Prevalence and risk factors of Strongyloides stercoralis infection among Orang Asli schoolchildren: new insights into the epidemiology, transmission and diagnosis of strongyloidiasis in Malaysia

“…Humans acquire S. stercoralis infection generally through skin penetration of filariform larvae that exist in contaminated soil. Moreover, donor-derived strongyloidiasis infection in solid organ transplant recipients is increasingly being reported (Kim et al ., 2016; Winnicki et al ., 2018). Strongyloidiasis is commonly chronic and long lasting with a majority of infected individuals remaining asymptomatic, and infections could be sustained in individuals for more than 75 years (Prendki et al ., 2011; Junior et al ., 2017).…”