Medline ® Abstracts for References 7,8
Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis.
Kim JH, Kim DS, Yoon YK, Sohn JW, Kim MJ
Transplant Proc. 2016 Sep;48(7):2442-2449.
BACKGROUND: Donor-derived Strongyloides stercoralis infection in solid organ transplant (SOT) recipients is uncommon. Immunosuppressed SOT recipients are at risk of developing severe forms of strongyloidiasis infection through transmission from an infected donor allograft.
METHODS: PubMed was searched for English-written articles published up to April 2015. Articles that reported cases of donor-derived strongyloidiasis infection in SOT recipients were reviewed for a pooled analysis.
RESULTS: A total of 27 cases were identified from various SOT recipients. Donors were mostly from Strongyloides endemic regions (23 cases). No transplant recipients received prophylaxis against strongyloidiasis infection. Median age was 53 years. Median time of presenting symptoms after the solid organ transplantation was 72 days. The most common presenting symptoms were gastrointestinal (GI) symptoms (19 cases; 70.4%). Diagnosis of strongyloidiasis infection was mainly made by the confirmation of Strongyloides larvae or worm in GI samples (19 cases) and respiratory samples (14 cases). Donor-derived strongyloidiasis infection was evidenced by serology test results in 17 cases and epidemiological risk assessment analysis in 10 cases. Ivermectin was the most commonly used medication with use of a combination of iverrmectin and albendazole or thiabendazole in 15 cases. Death was noted in 9 cases (34.6%) of 26 cases with known outcomes. Presence of sepsis or bacteremia was a predictor of mortality because it was seen in 9 patients who died (100.0%) and in 4 patients who survived (23.5%; P <.001).
CONCLUSIONS: Donor-derived strongyloidiasis infection in SOT recipients has high mortality. Effective donor screening and prophylaxis in high-risk SOT recipients may help to decrease morbidity and mortality associated with donor-derived strongyloidiasis.
Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Donor-derived Strongyloides stercoralis infection in solid organ transplant recipients in the United States, 2009-2013.
Abanyie FA, Gray EB, Delli Carpini KW, Yanofsky A, McAuliffe I, Rana M, Chin-Hong PV, Barone CN, Davis JL, Montgomery SP, Huprikar S
Am J Transplant. 2015 May;15(5):1369-75.
Infection with Strongyloides stercoralis is typically asymptomatic in immunocompetent hosts, despite chronic infection. In contrast, immunocompromised hosts such as solid organ transplant recipients are at risk for hyperinfection syndrome and/or disseminated disease, frequently resulting in fatal outcomes. Infection in these recipients may result from reactivation of latent infection or infection through transmission from an infected donor. We describe the Centers for Disease Control and Prevention's experience with seven clusters of donor-derived infection from 2009 to 2013. Six of the seven (86%) donors were born in Latin America; donor screening was not performed prior to organ transplantation in any of these investigations. Eleven of the 20 (55%) organ recipients were symptomatic, two of whom died from complications of strongyloidiasis. We also describe the New York Organ Donor Network (NYODN) experience with targeted donor screening from 2010 to 2013. Of the 233 consented potential donors tested, 10 tested positive for Strongyloides antibody; and 18 organs were transplanted. The majority (86%) of the donors were born in Central or South America. Fourteen recipients received prophylaxis after transplantation; no recipients developed strongyloidiasis. The NYODN experience provides evidence that when targeted donor screening is performed prior to transplantation, donor-derived infection can be averted in recipients.
Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control Prevention, Atlanta, GA.