Strongyloides Stercoralis Hyperinfection Transmitted by Liver Allograft in a Transplant Recipient

Abstract

We describe a case of Strongyloides stercoralis hyperinfection in a liver allograft recipient 2.5 months after transplantation. The patient lives in Spain, which is not considered an endemic country for strongyloidiasis, and denied prior residence or travel to any known endemic area. The initial symptoms were fever and vomiting, and he subsequently developed a severe respiratory disease. An endoscopic biopsy of ulcerative lesions of the duodenum revealed massive mucosa infiltration by larvae and adult worms, which were also found in respiratory samples. The patient was successfully treated with combined therapy with albendazole and ivermectin. The strongyloides infection was transmitted by the liver allograft. The donor was from Ecuador and, retrospectively, his serum tested positive for S. stercoralis IgG antibodies. Additionally, the pancreas-left kidney allograft recipient from the same donor later developed an intestinal strongyloidiasis without hyperinfection syndrome. To our knowledge, this is the first confirmed case of S. stercoralis infection transmission from the same donor to two solid allograft recipients.

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.…”

“…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.…”

Recurrent Streptococcus bovis Meningitis in Strongyloides stercoralis Hyperinfection after Kidney Transplantation: The Dilemma in a Non-Endemic Area

“…Donor-linked parasitic transmission has been suspected in transplant recipients who received organs from donors from endemic areas or proven when different recipients developed Ss after receiving different organs from the same donor. [6][7][8] In our case, it is unlikely that this infection was donor derived because the recipient of the sister kidney did not develop any symptoms, and neither a donor eosinophil count nor a donor serum sample was available to confirm Ss IgG antibodies with enzyme-linked immunosorbent assay (ELISA). 5 Cyclosporine A has been reported to confer immunity against Ss 9 but both kidney recipients in this case were receiving tacrolimus.…”

“…Meningeal symptoms, the positive CSF culture and the E. coli from the sputum represent the bacteremia associated with unrestricted larval migration through the bowel wall 6,11 that can result in a high incidence of S. bovis meningitis, especially after steroid therapy. 12 The ability to cause autoinfection makes this parasite particularly virulent, which in immunocompromised recipients can result in the hyperinfection syndrome with larval proliferation in various organs including the lungs, kidneys, thyroid and the brain, with serious consequences.…”

Fatal disseminated strongyloidiasis after kidney transplantation

“…The larvae can reach the circulation and disseminate to multiple organs 5 . The occurrence of strongyloidiasis has been reported increasingly after organ transplantation, including heart, liver, pancreas, intestine, and kidney transplantation, even in non-endemic countries [6][7][8][9] . After receiving the patient's consent, we report the case of a kidney transplant recipient who presented with fatal DS.…”