Donor‐derived strongyloidiasis after organ transplantation in Norway

Abstract

Strongyloides stercoralis is an intestinal helminth which in humans can cause asymptomatic chronic infection maintained for decades through its auto-infective cycle.During solid organ transplantation, recipients may unintentionally receive an organ infected with strongyloides. This is a very rare complication but may have deadly outcome if not detected. We hereby report two transplant recipients whom developed Strongyloides hyperinfection syndrome after organ transplantation from the same deceased donor. Recipient 1 was kidney transplanted and presented at day 65 post engraftment with diarrhea and subsequent septicemia and gastric retention. Larvae were detected in gastric aspirate. Recipient 2 was simultaneously kidney and pancreas transplanted and presented at day 90 post engraftment also with gastric retention and septicemia. Larvae were demonstrated on duodenal biopsy and stool sample. The clinical course was complicated with severe duodenal bleedings, gastric retention, meningitis, and prolonged hospitalization. Retrospective testing of pretransplant donor serum was positive for Strongyloides stercoralis antibodies. As a result of disease severity and gastric retention albenazole was administered via a jejunal tube and ivermectin subcutaneously in both recipients. S stercoralis was successfully eradicated and the transplants ended up with unaffected graft function. Following

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

“…Thirdly, although the infection is rarely transmitted from person to person [10], it can be transmitted through organ transplantation, and autochthonous cases have been reported in non-endemic areas [11]. Therefore, screening should be considered for potential donors at risk of the infection [12][13][14]. Finally, in the case of immunosuppression, particularly those displaying a concomitant use of steroids, transplant recipients, or patients with malignancies and Human T-Cell Lymphotropic virus-1 co-infections, the parasite may enter into a high replicating cycle (called hyperinfection) or disseminate to vital organs (disseminated strongyloidiasis), causing a severe disease with a high mortality [15].…”

Strongyloidiasis in Solid Organ Transplantation

“…Sexual transmission of S. stercoralis has been seen in men who have sex with men [39]. Donor-derived infections in SOT recipients have also been described [3][4][5][6][7][8][9][10][11]. Infant infection with S. fuelleborni has been suspected to be acquired through the breastmilk of nursing mothers [27,40].…”

“…Donor-derived strongyloidiasis in SOT is rare but has been reported to occur [3][4][5][6][7][8][9][10][11]. The first possible transmission was reported in 1981 when two kidney transplant recipients developed hyperinfection syndrome after receiving allografts from the same deceased donor [3].…”

“…The occurrence of donor-derived strongyloidiasis has recently become increasingly recognized and reported [3][4][5][6][7][8][9][10][11]. Standard diagnostic tests have long been acknowledged to have suboptimal performance characteristics and this has led to the development of newer diagnostic assays including use of the polymerase chain reaction (PCR) [12][13][14][15][16].…”

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

“…Third, although the infection is rarely transmitted through person to person, [10] it can be transmitted through organ transplantation, and autochthonous cases have been reported in nonendemic areas [11]. Thus, screening should be considered in potential donors at risk of the infection [12][13][14]. Finally, in case of immunosuppression, particularly described with the concomitant use of steroids, transplant recipients or patients with malignancies and Human T-Cell Lymphotropic virus-1 co-infections, the parasite may enter into a high replicating cycle (called hyperinfection) or disseminate to vital organs (disseminated strongyloidiasis), causing a severe disease with high mortality [15].…”