Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis

Kim, J.H.; Kim, D.S.; Yoon, Young Kyung; Sohn, Jang Wook; Kim, M.J.

doi:10.1016/j.transproceed.2015.11.045

Cited by 46 publications

(49 citation statements)

References 27 publications

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“…Alternatively, a small number of Strongyloides larvae may be present in organs outside of the gastrointestinal tract in the absence of reported symptoms. Mortality rates in donor‐derived Strongyloides infection are high, approaching 80% in those with disseminated disease or hyperinfection syndrome . The presence of sepsis or bacteremia is a predictor of mortality in cases of donor‐derived Strongyloides infections …”

Section: Discussionmentioning

confidence: 99%

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Camargo

Simkins

Anjan

et al. 2019

Clinical Transplantation

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Background Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor‐derived Strongyloides infection has occurred after heart, kidney, kidney‐pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis. Methods We report a fatal case of donor‐derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation. Results From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody‐positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post‐transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center. Conclusions Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient‐ and donor‐derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Camargo

Simkins

Anjan

et al. 2019

Clinical Transplantation

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“…Donor‐derived Strongyloides infection, although not common, has been reported among adult solid organ transplant recipients. A recent publication has identified a total of 27 donor‐derived S. stercoralis infections after solid organ transplantation . Most case reports highlight the fact that donors have been from areas where strongyloidiasis is highly prevalent .…”

Section: Discussionmentioning

confidence: 99%

“…In the immunocompromised patient, treatment failures have been reported with parasitic clearance taking up to 21‐30 days . Based on this, some authors have advocated for maintenance antiparasitic therapy, prolonged doses, or combination treatment when patients require additional immunosuppressive therapy or are presenting with hyperinfection or disseminated infection …”

Section: Discussionmentioning

confidence: 99%

“…A recent publication has identified a total of 27 donor-derived S. stercoralis infections after solid organ transplantation. 4 Most case reports highlight the fact that donors have been from areas where strongyloidiasis is highly prevalent. 5 Within Saudi Arabia, most reports have come from the Eastern Province.…”

Section: Discussionmentioning

confidence: 99%

“…3 Strongyloidiasis has been reported after solid organ transplantation (heart, liver, pancreas, intestine, and kidney). 4 In the transplant population, as a result of a weakened immune system, a condition of accelerated parasitic propagation known as hyperinfection may occur and lead to extraintestinal dissemination. 1 Patients are at risk of meningitis and sepsis from bacterial gut flora carried with migrating larvae; the associated mortality rate is as high as 87%.…”

Section: Introductionmentioning

confidence: 99%

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Donor‐derived strongyloidiasis in a Saudi pediatric kidney transplant recipient: A case report and mini‐review

Alsager

Waqar

Furrukh

et al. 2018

Pediatric Transplantation

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S. stercoralis infection has been identified as a donor‐derived infection in cases of solid organ transplant among recipients with no prior risk factor for parasitic exposure. Worldwide and regional reports from the adult kidney transplant population highlight this indirect method of infection and caution about delayed diagnosis, severe complications, and death related to donor‐derived S. stercoralis infection. We report a deceased‐donor‐derived S. stercoralis infection in a 12‐year‐old Saudi girl who underwent kidney transplantation. This is the first pediatric case reported outside the United States of America. Although she presented with mild bouts of gastrointestinal symptoms, the need for additional immune suppression put her at risk of serious complications. A literature review highlights the importance of awareness about S. stercoralis infections and complications in kidney transplant recipients, pretransplant screening of donors based on risk assessment, and the challenges with treatment availability and duration in this vulnerable population.

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Nematodes

Sheorey,

Biggs,

Bradbury

2023

ClinMicroNow

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Nematodes are unsegmented cylindrical worms with a body cavity containing an alimentary canal and genital system; the sexes are separate. They have longitudinal muscles, which allow them to move by flexing their bodies. Molecular diagnosis for intestinal nematodes is increasingly being introduced in diagnostic laboratories. There are a variety of morphological features and DNA sequences which form the basis for taxonomy of nematodes. The primary diagnosis of infection is by demonstration of A. lumbricoides eggs in feces. Albendazole is the first choice for treating A. lumbricoides , and mebendazole is also effective. Any helminth eggs or larvae found in feces are significant, and treatment is recommended even if the patient is asymptomatic. There is no need to quantitate helminth parasites in a diagnostic context, as this does not necessarily correlate with clinical illness.

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Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis

Cited by 46 publications

References 27 publications

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients

Donor‐derived strongyloidiasis in a Saudi pediatric kidney transplant recipient: A case report and mini‐review

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