Strongyloides stercoralis infection in transplanted patients

Abstract

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

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

“…There were 15 reports of S. stercoralis among HCT. 45 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 Overall, published studies originated predominantly from the US ( n = 43) 8 , 14 , 16 , 17 , 18 , 20 , 22 , 24 , 28 , 34 , 35 , 36 , 37 , 38 , 39 , 44 , 46 , 48 , 51 , 52 , 53 , 54 , 56 , 58 , 61 , 63 , 64 , 65 , 69 , 70 , 72 , 73 , 75 , 77 , 79 , 81 , 84 , 85 , 88 , 89 , …”

“…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 ...…”

Solid Organ Transplant and Parasitic Diseases: A Review of the Clinical Cases in the Last Two Decades

“…On the basis of published data, the most frequently intercurrent helminthic intestinal infection in SOT recipients seems to be strongyloidiasis [ 15 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 ], being occasionally reported infections by other intestinal helminths such as Trichuris trichiura [ 192 ], Ascaris lumbricoides [ 134 , 193 ] and Dipylidium caninum [ 194 ].…”

Gastrointestinal Side Effects of Post-Transplant Therapy

“…Even if there is only suspicion of an infection with Strongyloides stercoralis in a possible kidney donor, it is preferable to initiate the treatment with albendazole until the infection is eradicated. The same treatment can be administered to the transplant recipient [26,27]. It is worth noting that thiabendazole interferes in the liver with medications containing xanthine, but it does not interefere in its hepatic metabolism with the calcineurin inhibitors.…”