<i><scp>S</scp>trongyloides stercoralis</i> infection in allogeneic stem cell transplant: a case report and review of the literature

Iori, Anna Paola; Ferretti, Antonietta; Gentile, Giuseppe; Gabrielli, Simona; Perrone, Salvatore; Barberi, Walter; Torelli, Giovanni Fernando; Natalino, Fiammetta; Scalzulli, Emilia; Totino, Valentina; Foà, Robin; Cancrini, Gabriella; Girmenia, Corrado

doi:10.1111/tid.12239

Cited by 16 publications

(11 citation statements)

References 14 publications

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“…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,…”

Section: Resultsmentioning

confidence: 99%

“…A total of 72 studies 3,8–78 reported 91 SOT recipients, with 92 allografts and 93 episodes of S. stercoralis infection after SOT. There were 15 reports of S. stercoralis among HCT 45,79–92 . Overall, published studies originated predominantly from the US ( n = 43) 8,14,16–18,20,22,24,28,34–39,44,46,48,51–54,56,58,61,63–65,69,70,72,73,75 , 77,79,81,84,85,88–90,92 and Europe ( n = 18), 15,19,23,26,30,31,33,45,50,55,57,62,67 , 74,82,83,87,91 followed by the Asia‐Pacific region ( n = 15), 3,9–11 , 25,40–43,49,60,68,76,78,86 South America ( n = 9)…”

Section: Resultsmentioning

confidence: 99%

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

Abad

Bhaimia

Schuetz

et al. 2022

Clinical Transplantation

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Background:We reviewed the scientific literature to gain insight on the epidemiology and outcome of Strongyloides stercoralis infections after transplantation. Methods: CINAHL, PUBMED, and OVID/MEDLINE were reviewed from inception through March 31, 2022 using key words Strongyloides and transplantation. Results: Our review identified 108 episodes of Strongyloides infection among 91 solid organ transplant (SOT) and 15 hematopoietic cell transplant (HCT) recipients. Median time to infection was 10.8 (range, .14-417) and 8.8 (range, 0-208) weeks after SOT and HCT, respectively. Gastrointestinal symptoms were frequent (86/108 [79.6%]), while skin rash (22/108 [20.3%]) and fever (31/103 [30%]) were less common. Peripheral eosinophilia was observed in half of patients (41/77 [53.2%]). Bacteremia (31/59 [52.5%]) was frequently due to Gram-negative organisms (24/31 [77.4%]). Abnormal chest radiologic findings were reported in half (56/108 [51.9%]). The majority had hyperinfection syndrome (97/108 [89.8%]) while disseminated strongyloidiasis was less common (11/108 [10.2%]). Thirty-two cases were categorized as donorderived infection (DDI), with donors (23/24 [95.8%]) who had traveled to or lived in endemic areas. Median time to DDI was 8 weeks (range .5-34.3 weeks) after transplantation. Treatment consisted of ivermectin (n = 26), a benzimidazole (n = 27), or both drugs (n = 28). There was high all-cause mortality (48/107, 44.9%) and a high Strongyloides-attributable mortality (32/49, 65.3%).Conclusions: Strongyloidiasis should be strongly considered among recipients with epidemiologic risk factors for infection, even in the absence of eosinophilia or rash. A policy that provides guidance on pro-active screening is needed, to ensure preventive measures are provided to recipients at increased risk.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Abad

Bhaimia

Schuetz

et al. 2022

Clinical Transplantation

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“…Nevertheless, other recent reports have also described S . stercoralis infection in donors for both solid organ and stem cell transplants [ 20 , 21 ]. Since the origin of the donors is unknown for the four patients who had received a transplant, they cannot be ruled out as a possible source of infection.…”

Section: Discussionmentioning

confidence: 99%

Management of severe strongyloidiasis attended at reference centers in Spain

et al. 2018

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IntroductionStrongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this “gold standard” can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details.MethodsAn observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000–2015, in collaboration with eight reference centers throughout Spain.ResultsFrom the period 2000–2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21–70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1–164). Two cases received intensive care and eventually died.ConclusionsOnly eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.

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“…Patients from endemic areas and those with gastrointestinal symptoms or unexplained eosinophilia pre-HSCT should be screened with Strongyloides species immunoglobulin G enzyme-linked immunosorbent assay or stool screening if serologic testing is unavailable and treated with anti-parasitic therapy before HSCT. The diagnosis of strongyloidiasis post-HSCT can be challenging, as gastrointestinal symptoms may mimic those of GVHD, and a detailed exposure history may be the only significant factor to initiate evaluation for this infection [5,187].…”

Section: Strongyloidesmentioning

confidence: 99%

Stem Cell Transplantation: Infection Risk by Transplant Type and Emerging Trends in Infection Management

Satyanarayana¹,

Gatwood²,

Nesbitt³

2020

Emerging Transplant Infections

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Advances in the field of hematopoietic stem cell transplantation (HSCT) provide the opportunity for cure of malignant and nonmalignant diseases. The kinetics of immune reconstitution posttransplant and the immunosuppressive therapies used place HSCT recipients at risk for bacterial, viral, fungal, and other opportunistic infections. Identification of new donor sources of hematopoietic cells has improved accessibility to transplant but may lead to significant deficits in shortand long-term immune reconstitution as well as an increased risk of graft-versushost disease, which also impacts immune reconstitution. Additionally, new therapies used for the treatment of graft-versus-host disease have increased the risk for development of certain infections posttransplant. Understanding the many risk factors for infection in this patient population has allowed for improvement in infection identification and management, including development of new diagnostics and therapeutic modalities, which have decreased morbidity and mortality.

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Strongyloides stercoralis infection in allogeneic stem cell transplant: a case report and review of the literature

Cited by 16 publications

References 14 publications

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

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

Management of severe strongyloidiasis attended at reference centers in Spain

Stem Cell Transplantation: Infection Risk by Transplant Type and Emerging Trends in Infection Management

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