Donor-Derived Strongyloides stercoralis Infections in Renal Transplant Recipients

Abstract

These case studies provide some of the best evidence of transmission of S. stercoralis by renal transplantation. Because of the high risk of hyperinfection syndrome and its associated morbidity and mortality, high-risk donors and recipients should be screened for Strongyloides infection, so that appropriate treatment can be initiated before the development of disease. This study indicates that parenteral ivermectin can be used safely and effectively in patients in whom severe malabsorption would preclude the effective use of oral formulation. These cases also suggest that reconsideration should be given for the safety of steroids in donor-preconditioning regimens.

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.…”

“…Hyperinfection and dissemination carry significant morbidity and mortality with fatality rates reaching 85% (5,6,19). Hyperinfection and dissemination have been reported in patients with diabetes, hematologic malignancies, malnutrition, hypogammaglobulinemia and with the use of immunosuppressive drugs in autoimmune disease and organ transplantation (1,7,19). Patients with HTLV-1 are also at increased risk of Strongyloides infections because the virus increases interferon-gamma production and decreases IL-1, IL-3, IL-5 and IgE, which play an important role in parasitic defense (19).…”

“…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.…”

Real-Time Polymerase Chain Reaction in Stool Detects Transmission of Strongyloides stercoralis from an Infected Donor to Solid Organ Transplant Recipients

“…This case adds to the existing reports of S. stercoralis transmission from donors to SOT recipients, [2][3][4][5] but there are some important differences in our case. All donor-to-recipient transmissions described so far were investigated when at least one SOT recipient presented with severe strongyloidiasis.…”

“…1 In recent years, some authors have reported the transmission of S. stercoralis from infected donors to recipients. [2][3][4][5] Interestingly, most cases were diagnosed when recipients presented with hyperinfection syndrome and donors were found to have S. stercoralis on retrospective testing.…”