Strongyloides infection screening in transplant candidates: What is the best strategy?

Abstract

BackgroundThe potential that Strongyloides stercoralis infection has to cause major morbidity and high mortality when the disseminated form occurs in transplant patients is of particular concern.MethodsIn this study, the objective was to observe S. stercoralis infection in patients who are candidates for transplantation by using parasitological, serological, and molecular techniques and to propose an algorithm for the detection of that infection in transplant candidates.ResultsBy parasitological techniques, 10% of fecal samples were positive. Anti‐Strongyloides antibodies immunoglobulin G were detected in 19.3% and 20.7% of patients by immunofluorescence assay and enzyme‐linked immunosorbent assay, respectively. S. stercoralis DNA was observed in 17.3% of samples by conventional polymerase chain reaction and 32.7% of samples by quantitative polymerase chain reaction (qPCR).ConclusionThe set of results allows us to reinforce that a positive result by parasitological techniques and/or qPCR indicates that the specific treatment should be applied. However, the improvement of diagnostic techniques may suggest changes in the screening for strongyloidiasis in these patients. image

Detection of Anti‐Strongyloides Antibodies in the Serum of Liver Transplant Recipients: Need of Screening for This Neglected Helminthiasis

“…It is important to emphasise that the degree of impairment of the immune system can directly compromise the positivity of the serological test [2,4,13]. This fact may explain the lower positivity by ELISA in the present study (10.9%) in comparison with the results (14.7%) presented by Toledo et al [20] evaluating samples of candidates for transplants in the same hospital.…”

“…Literature agrees on the importance of screening for S. stercoralis infection in immunocompromised patients to avoid fatal outcomes [18,19]. Recently, our group proposed an algorithm for detecting S. stercoralis infection in transplant candidates [13], suggesting serology as an important diagnostic tool. Of the serum samples evaluated by ELISA, 5.4% (16/294) were considered reactive (RI > 1.0) (Figure 1A).…”

“…Therefore, serological testing can be considered as the appropriate approach. Recently, our group proposed an algorithm highlighting serological testing as an important tool for screening transplant candidates [13]. Given the global burden of strongyloidiasis and the increased prevalence of organ transplants, it is important to gather data on Strongyloides positivity in the transplant population to determine the best screening strategies [14].…”