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Hogan JI, Mehta SA. Strongyloides stercoralis infection in solid organ transplant recipients. Curr Opin Infect Dis 2024; 37:367-375. [PMID: 39082077 DOI: 10.1097/qco.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
PURPOSE OF REVIEW Strongyloides stercoralis infection remains of concern due to its high associated morbidity among solid organ transplant recipients (SOTR) and the risk of donor-derived infection (DDI). We review key aspects of epidemiology to inform screening for and treatment of chronic infection among organ transplant candidates to reduce the risk of infectious complications in the posttransplant setting. RECENT FINDINGS In this work, we offer guidance regarding the optimal management of Strongyloides hyperinfection syndrome and disseminated infection and offer recommendations regarding posttreatment surveillance and the potential need for repeat treatment during subsequent periods of augmented immunosuppression. This review also provides updated recommendations for screening of deceased and living donors as recently proposed by the Organ Procurement and Transplantation Network's Ad Hoc Disease Transmission Advisory Committee. SUMMARY Risk reduction of Strongyloides infection in the SOTR population can be further enhanced by optimized treatment of infection, posttreatment surveillance during at-risk periods and recent proposed policy shifts to universal donor screening.
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Affiliation(s)
| | - Sapna A Mehta
- NYU Grossman School of Medicine
- NYU Langone Transplant Institute, New York, New York, USA
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Corral MA, Meisel DMCL, Gouvêa MSG, Pessoa MG, Abdala E, Terrabuio DRB, da Costa IN, de Paula FM, Gryschek RCB. Detection of Anti-Strongyloides Antibodies in the Serum of Liver Transplant Recipients: Need of Screening for This Neglected Helminthiasis. Parasite Immunol 2024; 46:e13059. [PMID: 39039790 DOI: 10.1111/pim.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
Immunosuppressed patients, particularly transplant recipients, can develop severe strongyloidiasis. This study aimed to detect anti-Strongyloides IgG antibodies in a panel of sera from liver transplant patients. Two techniques were used: ELISA as the initial screening test and Western blotting as a confirmatory test. ELISA reactivity of 10.9% (32/294) was observed. The 40-30 kDa fraction was recognised in 93.7% (30/32) of the patients, resulting in a positivity rate of 10.2%. These data highlight the importance of serological screening for Strongyloides stercoralis infection in liver transplant recipients.
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Affiliation(s)
- Marcelo Andreetta Corral
- Laboratório de Investigação Médica (LIM-06), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Dirce Mary Correia Lima Meisel
- Laboratório de Investigação Médica (LIM-06), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Michele Soares Gomes Gouvêa
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Laboratório de Investigação Médica (LIM-07), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mario Guimarães Pessoa
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edson Abdala
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Idessania Nazareth da Costa
- Laboratório de Parasitologia, Departamento de Ciências Patológicas, Universidade Estadual de Londrina, Paraná, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM-06), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ronaldo Cesar Borges Gryschek
- Laboratório de Investigação Médica (LIM-06), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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3
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Rojas OC, Montoya AM, Villanueva-Lozano H, Carrion-Alvarez D. Severe strongyloidiasis: a systematic review and meta-analysis of 339 cases. Trans R Soc Trop Med Hyg 2023; 117:682-696. [PMID: 37300462 DOI: 10.1093/trstmh/trad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/15/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Strongyloidiasis is a parasitosis representing a significant public health problem in tropical countries. It is often asymptomatic in immunocompetent individuals but its mortality rate increases to approximately 87% in severe forms of the disease. We conducted a systematic review, including case reports and case series, of Strongyloides hyperinfection and dissemination from 1998 to 2020 searching PubMed, EBSCO and SciELO. Cases that met the inclusion criteria of the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were analysed. Statistical analysis was performed using Fisher's exact test and Student's t-test and a Bonferroni correction for all the significant values. A total of 339 cases were included in this review. The mortality rate was 44.83%. The presence of infectious complications, septic shock and a lack of treatment were risk factors for a fatal outcome. Eosinophilia and ivermectin treatment were associated with an improved outcome.
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Affiliation(s)
- Olga C Rojas
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Alexandra M Montoya
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Hiram Villanueva-Lozano
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
| | - Diego Carrion-Alvarez
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
- Departamento de Ciencias Basicas, Universidad de Monterrey. N.L. Mexico. Av. Ignacio Morones Prieto 4500, San Pedro, Garza García, Nuevo Leon, Mexico
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Abad CLR, Bhaimia E, Schuetz AN, Razonable RR. A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation. Clin Transplant 2022; 36:e14795. [PMID: 35987856 PMCID: PMC10078215 DOI: 10.1111/ctr.14795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022]
Abstract
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 donor-derived 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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Affiliation(s)
- Cybele Lara R Abad
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila, Philippines
| | - Eric Bhaimia
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, and The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| | - Raymund R Razonable
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, and The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
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Ottino L, Buonfrate D, Paradies P, Bisoffi Z, Antonelli A, Rossolini GM, Gabrielli S, Bartoloni A, Zammarchi L. Autochthonous Human and Canine Strongyloides stercoralis Infection in Europe: Report of a Human Case in An Italian Teen and Systematic Review of the Literature. Pathogens 2020; 9:E439. [PMID: 32503315 PMCID: PMC7350350 DOI: 10.3390/pathogens9060439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61-70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode.
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Affiliation(s)
- Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, 70124 Bari, Italy;
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
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Cipriano A, Dias R, Marinho R, Correia S, Lopes V, Cardoso T, Aragão I. Donor-derived fatal hyperinfection strongyloidiasis in renal transplant recipient. IDCases 2020; 19:e00703. [PMID: 32021802 PMCID: PMC6992991 DOI: 10.1016/j.idcr.2020.e00703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Abstract
Strongyloides stercoralis is a nematode, endemic in tropical and subtropical areas. Strongyloidiasis has been reported in recipients of hematopoietic stem cells, kidney, liver, heart, intestine, and pancreas, eventually presenting as disseminated strongyloidiasis and hyperinfection syndrome (SHS) which is associated with high mortality. We report one case of a recent renal transplant recipient, who presented with gastrointestinal and respiratory symptoms, evolving into shock. The identification of Strongyloides stercoralis in the bronchoalveolar lavage (BAL) lead us to the diagnosis of SHS. Treatment with subcutaneous ivermectin was started, however the patient did not survive. Retrospective serum donor analysis allowed us to identify the donor as the source of infection.
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Affiliation(s)
- Ana Cipriano
- Infectious Disease Department, Centro Hospitalar do Porto, Portugal
| | - Rita Dias
- Internal Medicine Department, Centro Hospitalar do Porto, Portugal
| | - Ricardo Marinho
- Internal Medicine Department, Centro Hospitalar do Porto, Portugal
| | - Sofia Correia
- Nephrology and Transplant Unit, Centro Hospitalar do Porto, Portugal
| | - Virgínia Lopes
- Clinical Microbiology Department, Centro Hospitalar do Porto, Portugal
| | - Teresa Cardoso
- Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal
| | - Irene Aragão
- Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal
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Wang WL, Zhang QW, Tang S, Chen F, Zhang JB. Co-infection with Strongyloides stercoralis hyperinfection syndrome and Klebsiella in a nephrotic syndrome patient: A case report. Medicine (Baltimore) 2019; 98:e18247. [PMID: 31804353 PMCID: PMC6919406 DOI: 10.1097/md.0000000000018247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RATIONALE Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked. In immunosuppressed patients, mortality is high because of disseminated infection and hyperinfection. This report describes a fatal S stercoralis hyperinfection in a patient with nephrotic syndrome after treatment with steroids. PATIENT CONCERNS A 70-year-old male presented with a history of progressive edema, skin infection, persistent fever, cough, intermittent abdominal pain, and progressive respiratory failure after steroid treatment. DIAGNOSIS Nephrotic syndrome; cellulitis; S stercoralis hyperinfection; Klebsiella pneumonia. INTERVENTIONS During the first hospital admission, the patient was administered full-dose glucocorticoid and antibiotic therapy after suffering from cellulitis. During the second admission, he was diagnosed and treated for normal digestive discomfort and a bacterial infection. The patient had progressive respiratory failure and was placed on a ventilator. He was immediately treated with albendazole when S stercoralis was found in samples of his sputum and feces. OUTCOMES The patient died despite treatment with albendazole and antibiotic therapy. LESSONS It is essential to consider the possibility of S stercoralis infection in immunosuppressed patients with nephrotic syndrome. Given the lack of classic manifestations and high mortality rate of advanced disease, continuous monitoring, early diagnosis, and proper treatment are imperative.
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Hakeem I, Moritz C, Khan F, Garrett E, Narayanan M. Strongyloidiasis hyperinfection after renal transplant presenting as diffuse alveolar hemorrhage with respiratory failure. Proc AMIA Symp 2019; 32:413-416. [PMID: 31384205 PMCID: PMC6650283 DOI: 10.1080/08998280.2019.1596440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 01/07/2023] Open
Abstract
Strongyloides stercoralis is a helminthic enteric parasite estimated to infect at least 30 to 100 million people globally. It is transmitted via contaminated soil with a unique ability to complete its entire life cycle in the human host. It is common in humid, tropical, and subtropical regions of the world and is endemic in the Southeastern United States. Strongyloidiasis hyperinfection has been described in a variety of conditions that impair host immunity, including immunosuppression after transplantation. The syndrome has a high mortality rate but may initially present with nonspecific symptoms. A high degree of clinical suspicion coupled with early detection and aggressive therapeutic measures is paramount to a successful outcome.
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Affiliation(s)
- Imtiyaz Hakeem
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Charles Moritz
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Faiza Khan
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Erin Garrett
- Department of Anatomic Pathology, Scott & White Medical CenterTempleTexas
| | - Mohanram Narayanan
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
- Corresponding author: Mohanram Narayanan, MD, Chief,Section of Clinical Transplantation, Division of Nephrology and Hypertension, Scott & White Medical Center2601 Thornton LaneTempleTX 76502 (e-mail:)
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