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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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Fayyaz A, Raja M, Natori Y. Prevention and Management of Infections in Lung Transplant Recipients. J Clin Med 2023; 13:11. [PMID: 38202018 PMCID: PMC10779253 DOI: 10.3390/jcm13010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 01/12/2024] Open
Abstract
Anti-rejection medications are essential in preventing organ rejection amongst solid organ transplant recipients; however, these agents also cause profound immunosuppression, predisposing lung transplant recipients (LTRs) to infectious complications. The timely management including prevention, diagnosis, and treatment of such infectious complications is vital to prevent significant morbidity and mortality in solid organ transplant recipients and allograft dysfunction. LTRs are inundated with microbes that may be recognized as commensals in hosts with intact immune systems. Bacterial infections are the most common ones, followed by viral pathogens. Indications of a brewing infectious process may be subtle. Hence, the importance of adapting vigilance around isolated hints through symptomatology and signs is pivotal. Signals to suggest an infectious process, such as fever and leukocytosis, may be dampened by immunosuppressive agents. One must also be vigilant about drug interactions of antibiotics and immunosuppressive agents. Treatment of infections can become challenging, as antimicrobials can interact with immunosuppressive agents, and antimicrobial resistance can surge under antimicrobial pressure. Transplant infectious disease physicians work in concert with transplant teams to obtain specimens for diagnostic testing and follow through with source control when possible. This heavily impacts medical decisions and fosters a multidisciplinary approach in management. Furthermore, the reduction of immunosuppression, although it augments the risk of allograft rejection, is as crucial as the initiation of appropriate antimicrobials when it comes to the management of infections.
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Affiliation(s)
| | | | - Yoichiro Natori
- Miami Transplant Institute, Jackson Health System, Division of Infectious Disease, Department of Clinical Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.F.); (M.R.)
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Yeh MY, Aggarwal S, Carrig M, Azeem A, Nguyen A, Devries S, Destache C, Nguyen T, Velagapudi M. Strongyloides stercoralis Infection in Humans: A Narrative Review of the Most Neglected Parasitic Disease. Cureus 2023; 15:e46908. [PMID: 37954715 PMCID: PMC10639005 DOI: 10.7759/cureus.46908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Strongyloidiasis is a helminth infection affecting 613.9 million people annually, mainly in the tropics and subtropics. The reported seroprevalence in the United States is 4% with most of the cases reported in immigrants. Human T-lympho-tropic virus 1 (HTLV-1) infections, hypogammaglobulinemia, immunosuppressant use - particularly steroid use, alcoholism, and malnutrition have been associated with an increased risk of strongyloidiasis. Recently, cases of strongyloidiasis hyperinfection syndrome have been described in coronavirus disease 2019 (COVID-19) patients treated with steroids as well. This brief review discusses the epidemiology, clinical features, management, and prevention of strongyloidiasis including some facts about the infection in pregnancy, transplant recipients, and COVID-19 patients. We conducted an online search using the PubMed, Scopus, and Google Scholar databases. Strongyloidiasis can be asymptomatic or present with mild symptoms. Strongyloides stercoralis is known to cause autoinfection. In immunocompromised individuals, it can present with severe symptoms, hyperinfection, or disseminated disease. Reported mortality in cases of disseminated Strongyloidiasis is 87.1%. Serology and detection of larvae in stool by direct microscopy are the most commonly used methods to diagnose strongyloidiasis. The drug of choice for the treatment is ivermectin. However, the use of ivermectin in human pregnancy is not well studied, and its teratogenic risks are unknown. Proactive screening of strongyloidiasis is necessary in immunocompromised individuals to prevent severe disease.
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Affiliation(s)
- Mary Y Yeh
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Sanjana Aggarwal
- Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Margaret Carrig
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ahad Azeem
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
| | - Anny Nguyen
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Chris Destache
- Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, USA
| | - Toan Nguyen
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Manasa Velagapudi
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
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Mota AMDV, Silva L, Girao ES, Costa De Oliveira CM. Disseminated Strongyloidiasis in Renal Transplant Recipient Complicated with Neurological Manifestations. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2023. [DOI: 10.5812/archcid-116309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Introduction: Infections caused by Strongyloides stercoralis are quite difficult to detect. It can remain silent long before manifesting, which used to occur when patients were under immunosuppressed conditions. This scenario makes the patient’s treatment and recovery hard to deal with. Case Presentation: This paper reports the case of a renal transplant patient who presented disseminated strongyloidiasis infection complicated with neurological manifestations. In order to eliminate Strongyloides stercoralis, the patient initially received oral Ivermectin treatment, and as the infection persisted, parenteral treatment was provided. The patient developed flaccid tetraparesis and increased cerebrospinal fluid protein with albumin- cytological dissociation, initially suggesting the diagnosis of Guillain-Barré syndrome. Conclusions: This clinical report highlights the need for early diagnosis and treatment in cases of immunosuppressed patients with strongyloidiasis infection, as the diagnosis might be neglected.
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Cai DH, Wang J, Fang XL. Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report. BMC Infect Dis 2022; 22:749. [PMID: 36153480 PMCID: PMC9509572 DOI: 10.1186/s12879-022-07670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal.
Case presentation
We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient’s life could not be saved.
Conclusion
This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.
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Endemic parasitic infections in donors and recipients of stem cell and solid organ transplants: focus on strongyloidiasis and Chagas disease. Curr Opin Infect Dis 2021; 34:323-332. [PMID: 34074878 DOI: 10.1097/qco.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of the article is to review recent recommendations on the management of Strongyloidiasis and Chagas disease (ChD) in the context of stem-cell or solid-organ transplantation. RECENT FINDINGS An update on laboratory screening, detection of acute disease or reactivation and recommended preventive or therapeutic options in the transplant recipients and donors is presented. Recent epidemiological data showing new estimates on the worldwide burden of both diseases and changes in the classical distribution around the globe should increase awareness and will impact the evaluation and management of transplant recipients and donors in endemic and nonendemic regions. SUMMARY Strongyloidiasis and ChD are potentially life threatening if unnoticed in the context of stem-cell or solid-organ transplantation and should be considered in endemic and nonendemic areas. Effective strategies for detection, monitoring, prevention and management are available for both diseases.
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Ryu H, Narayanan N, Bhatt PJ. Prevention of infection and optimizing vaccination in the solid organ transplant candidate and recipient. Curr Opin Organ Transplant 2021; 26:445-455. [PMID: 34227584 DOI: 10.1097/mot.0000000000000902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Infections can result in serious complications in solid organ transplant (SOT) patients. The need to remain up to date on recommendations on screening, vaccinations, and chemoprophylaxis is paramount in the management of SOT patients. The goal of this review is to provide an overview of current recommendations for the prevention of infections and optimization of vaccinations from the pretransplant through posttransplant periods. RECENT FINDINGS There is an emphasis on thorough pretransplant evaluation to guide clinicians and pretransplant testing based on epidemiological and endemic risk factors. Additionally, recent studies on vaccine safety and efficacy of newer vaccine formulations in SOT recipients are addressed. SUMMARY This review provides insight on updated recommendations for pretransplant screening, new data on vaccine optimization in SOT recipients and posttransplant prophylaxis. Further research is needed in order to improve preventive measures including screening tests, vaccines, and chemoprophylaxis.
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Affiliation(s)
- HaYoung Ryu
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick
| | - Navaneeth Narayanan
- Department of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of Pharmacy, Piscataway
- Division of Allergy/Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pinki J Bhatt
- Department of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of Pharmacy, Piscataway
- Division of Allergy/Immunology and Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Hermanns V, Flick H, Lingscheid T. Seltene parasitäre Infektionen der Lunge. DER PNEUMOLOGE 2020; 17:330-337. [PMID: 32837495 PMCID: PMC7374075 DOI: 10.1007/s10405-020-00336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pulmonale parasitäre Infektionen kommen weltweit vor, werden jedoch aufgrund der Seltenheit in Deutschland in den wenigsten Fällen differenzialdiagnostisch in Betracht gezogen. Parasitäre Lungenerkrankungen können unterschiedlichste pulmonale Manifestationen hervorrufen und sollten bei unklaren Befunden oder fehlendem Therapieansprechen differenzialdiagnostisch mit bedacht werden, um diese heilbaren Erkrankungen so früh wie möglich zu erkennen.
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Muhi S, Ko DK, McGuinness SL, Biggs BA, Mahanty S, Delany C. A mixed-method analysis of screening for Strongyloides stercoralis prior to immunosuppression: A problem of limited bandwidth? Intern Med J 2020; 52:790-799. [PMID: 32687250 DOI: 10.1111/imj.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Guidelines recommend screening for strongyloidiasis prior to immunosuppression in those at epidemiological risk, as hyperinfection following immunosuppression is often fatal. The uptake of this recommendation is unknown, and we aimed to explore this in our setting. AIMS Determine the proportion of adult patients at epidemiological risk for strongyloidiasis who were screened prior to immunosuppression at the Royal Melbourne Hospital, Explore the factors that influenced clinicians' decision to screen for strongyloidiasis prior to immunosuppression. METHODS This study used a mixed-methods approach. First, a 12-month (1 January 2018 to 1 January 2019) retrospective observational study was used to quantify the proportion of those at epidemiological risk who were screened prior to immunosuppression, while also identifying variables that were positively or negatively associated with screening. Second, clinicians from relevant specialties were recruited for focus group sessions to explore factors that influenced their decision to screen according to an interpretivist framework. RESULTS 230 newly immunosuppressed patients at epidemiological risk of strongyloidiasis were identified, of whom 87 (37.8%) were screened prior to immunosuppression. In multivariate analysis, older patients, outpatients and people from non-English speaking backgrounds were significantly less likely to be screened. In focus groups, a number of barriers and enablers to screening were identified. Notably, clinicians reported that a major barrier was the cognitive load required to clinically reason about this uncommon disease, in addition to other priorities. CONCLUSION We identified many missed opportunities to screen patients at risk of hyperinfection, particularly those most vulnerable. To improve screening, this study highlights the importance of reducing cognitive load by using decision-support tools, which may facilitate screening in vulnerable patients and in time-constrained settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stephen Muhi
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Dong-Kyoon Ko
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service
| | - Sarah L McGuinness
- Department of Infectious Diseases at the Alfred Hospital.,School of Public Health and Preventative Medicine, Monash University
| | - Beverley-Ann Biggs
- The Royal Melbourne Hospital, Victorian Infectious Diseases Service.,Department of Medicine at the Peter Doherty Institute, University of Melbourne
| | | | - Clare Delany
- Department of Medical Education at The University of Melbourne
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Screening of donors and recipients for infections prior to solid organ transplantation. Curr Opin Organ Transplant 2020; 24:456-464. [PMID: 31290846 DOI: 10.1097/mot.0000000000000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review is a brief overview of current guidelines on screening donors and candidates for bacterial, fungal, parasitic and viral infections prior to solid organ transplantation. The pretransplant period is an important time to evaluate infection exposure risk based on social history as well as to offer vaccinations. RECENT FINDINGS One of the major changes in the past few years has been increased utilization of increased Public Health Service risk, HIV positive, and hepatitis C-positive donors. There has also been increased attention to donor and recipient risks for geographically associated infections, such as endemic fungal infections and flaviviruses. SUMMARY Screening for donors and candidates prior to organ transplantation can identify and address infection risks. Diagnosing infections in a timely manner can help guide treatment and additional testing. Use of necessary prophylactic treatment in organ recipients can prevent reactivation of latent infections and improve posttransplant outcomes.
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Elzein F, Albahili H, Bahloul A, Alonazi T, Alghamdi A, Alsufyani E, Musa A, Alsaeed M. Transplant-related strongyloidiasis in solid organ transplant recipients in Saudi Arabia and the Gulf Cooperation Council countries. Int J Infect Dis 2020; 93:133-138. [PMID: 31982623 DOI: 10.1016/j.ijid.2020.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Strongyloidiasis is a devastating disease with a mortality rate exceeding 50% in immunocompromised patients. The disease usually results from reactivation of a latent infection in a transplant patient. Alternatively, donor-derived transmission of Strongyloides may occur. METHODS In this review, we report a case of Strongyloides hyperinfection syndrome in a liver transplant recipient to illustrate the severity of this infection. Following this, PubMed was searched for cases of transplant-related strongyloidiasis in the Gulf Cooperation Council (GCC) countries. Demographic data, the clinical presentation of recipients, and donor information were recorded. Methods of diagnosis, treatment planning, and clinical outcomes were documented. RESULTS A total of 12 transplant-related strongyloidiasis cases were identified. Seventy-five percent of the patients were from Saudi Arabia. Three cases from Kuwait shared common donors. All donors were deceased and native to an area endemic for Strongyloides. Five of the patients shared common donors, raising the possibility of donor-derived infection. Neither the donors nor the recipients underwent screening tests for Strongyloides. Concomitant bacteremia and/or meningitis was seen in 50% of cases (6/12). Moreover, when documented, sepsis was detected in all of the patients who died (three cases). The mortality rate in this series was high (41.7%). CONCLUSIONS Since this is a preventable condition, early diagnosis and treatment is essential. The screening and treatment of potential transplant recipients and donors proved to be an effective preventive measure. There is a growing need for further studies and implementation of screening policies in the GCC countries to prevent this fatal infection.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Hamad Albahili
- Liver Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Abdelkarim Bahloul
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Thamer Alonazi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Adnan Alghamdi
- Intensive Care Services Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Abdullatif Musa
- Liver Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mohammed Alsaeed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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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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Strongyloides stercoralis Infection in Solid Organ Transplant Recipients: a Case-Cohort Report at a Single-Center Experience. CURRENT TROPICAL MEDICINE REPORTS 2019. [DOI: 10.1007/s40475-019-00185-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Camargo JF, Simkins J, Anjan S, Guerra G, Vianna R, Salama S, Albright C, Shipman E, Montoya J, Morris MI, Abbo LM. Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients. Clin Transplant 2019; 33:e13497. [PMID: 30773692 DOI: 10.1111/ctr.13497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/09/2019] [Accepted: 02/09/2019] [Indexed: 01/21/2023]
Abstract
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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Affiliation(s)
- Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques Simkins
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Shweta Anjan
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Sam Salama
- Life Alliance Organ Recovery Agency, Miami, Florida
| | | | | | | | - Michele I Morris
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Lilian M Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Campo-Polanco LF, Sarmiento JMH, Mesa MA, Franco CJV, López L, Botero LE, Builes LAG. Strongyloidiasis in humans: diagnostic efficacy of four conventional methods and real-time polymerase chain reaction. Rev Soc Bras Med Trop 2018; 51:493-502. [PMID: 30133633 DOI: 10.1590/0037-8682-0055-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Strongyloides stercoralis is an intestinal parasitic nematode that causes hyperinfection and/or a dissemination syndrome in hosts, which is often difficult to diagnose. This study aims to compare the diagnostic efficacy of four conventional methods used to diagnose strongyloidiasis with real-time polymerase chain reaction (qPCR) to detect S. stercoralis in fecal samples. METHODS We analyzed 143 fecal samples collected from Colombian regions with varying degrees of risk for intestinal infections caused by S. stercoralis to assess the validity, performance, overall efficiency, and concordance of the qPCR using a direct stool test, modified Ritchie concentration technique, agar plate culture, and Harada-Mori technique as reference tests. RESULTS While four fecal samples were positive for S. stercoralis using conventional methods, 32 were positive via qPCR. The diagnostic sensitivity of the qPCR was 75% [95% confidence interval (CI): 20.07-100%], whereas its specificity, negative predictive value, negative likelihood ratio, and Youden's J index were 78.42% (95% CI: 71.22-85.62%), 99.09% (95% CI: 96.86-100%), 0.32 (95% CI: 0.06-1.74), and 0.53, respectively. In addition, the estimated kappa index between the qPCR and the conventional methods was 0.12 (95% CI: -0.020-0.26). CONCLUSIONS The diagnostic sensitivity of qPCR to detect strongyloidiasis is analogous to that of conventional parasitology methods, with an additional advantage of being capable of identifying the parasite DNA at low sample concentrations.
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Affiliation(s)
- Laura Francisca Campo-Polanco
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín ,Colombia
| | | | - Miguel Antonio Mesa
- Sección Reumatología, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Lucelly López
- Grupo Salud Publica, Escuela de Ciencias de la salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín ,Colombia
| | - Luz Elena Botero
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín ,Colombia
| | - Lina Andrea Gutiérrez Builes
- Grupo Biología de Sistemas, Escuela de Ciencias de la Salud, Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín ,Colombia
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16
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Konecny P, Weatherall CJ, Adhikari S, Duflou J, Marjoniemi V, Pretorius CJ, McWhinney B. Case Report: Subcutaneous Ivermectin Pharmacokinetics in Disseminated Strongyloides Infection: Plasma and Postmortem Analysis. Am J Trop Med Hyg 2018; 99:1580-1582. [PMID: 30334520 DOI: 10.4269/ajtmh.18-0387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Parenteral ivermectin treatment of disseminated strongyloidiasis and hyperinfection is increasing, although not licensed in humans and with limited pharmacokinetic data available. Plasma and postmortem tissue analysis in an human immunodeficiency virus (HIV)/hepatitis C virus-positive man with disseminated strongyloidiasis suggests loading subcutaneous ivermectin doses are required, from which the central nervous system is protected.
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Affiliation(s)
- Pamela Konecny
- University of New South Wales, Sydney, Australia.,St. George Hospital, Sydney, Australia
| | | | - Suman Adhikari
- University of New South Wales, Sydney, Australia.,St. George Hospital, Sydney, Australia
| | - Johan Duflou
- University of Sydney, Sydney, Australia.,Forensic Medicine Associates P/L, Sydney, Australia
| | - Veli Marjoniemi
- University of New South Wales, Sydney, Australia.,St. George Hospital, Sydney, Australia
| | - Carel J Pretorius
- School of Biomedical Sciences, University of Queensland, Brisbane, Australia.,Pathology Queensland, Brisbane, Australia
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17
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Nishio Lucar A, Knicely DH, Sifri CD. Late post-kidney transplant Strongyloides hyperinfection syndrome. Transpl Infect Dis 2018; 20:e12975. [PMID: 30107075 DOI: 10.1111/tid.12975] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/20/2018] [Accepted: 08/06/2018] [Indexed: 12/16/2022]
Abstract
Disseminated strongyloidiasis is a potentially life-threatening infection in organ transplant recipients that typically occurs within the first 6 months of transplantation. We discuss a patient from the Appalachia region of Virginia who appeared to acquire Strongyloides stercoralis domestically years after kidney transplantation and then develop disseminated strongyloidiasis.
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Affiliation(s)
- Angie Nishio Lucar
- Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Daphne H Knicely
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Costi D Sifri
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
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18
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19
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Deziel PJ, Razonable R. Anti-infective chemoprophylaxis after solid-organ transplantation. Expert Rev Clin Immunol 2018; 14:469-479. [PMID: 29764228 DOI: 10.1080/1744666x.2018.1476852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Solid organ transplant (SOT) recipients are at high risk of opportunistic infections due to bacterial, viral, fungal, and parasitic pathogens. Anti-infective prophylaxis is a time-tested proven strategy for the prevention of these infections after SOT. Areas covered: The current recommendations for the prevention of surgical site infections, herpes simplex, cytomegalovirus, invasive fungal infections, and selected parasitic diseases are highlighted. Recent peer-reviewed publications on the prevention of infection after SOT were reviewed and their significance was discussed in the context of the current recommendations for preventing infectious complications. Expert commentary: The authors comment on the current approaches to infection prevention in transplant recipients, and discuss how these recommendations are implemented in their clinical practice. Notable findings published during the past year were highlighted, and their clinical significance was interpreted in the context of current recommendations. The evolution of diagnostic and immunologic assays was emphasized, with focus on their potential role in optimizing the current antimicrobial approaches to infection prevention after SOT.
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Affiliation(s)
- Paul J Deziel
- a Division of Infectious Diseases, The William J von Liebig Center for Transplantation and Clinical Regeneration , Mayo Clinic College of Medicine and Science, Mayo Clinic , Rochester , MN , USA
| | - Raymund Razonable
- a Division of Infectious Diseases, The William J von Liebig Center for Transplantation and Clinical Regeneration , Mayo Clinic College of Medicine and Science, Mayo Clinic , Rochester , MN , USA
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20
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Abstract
PURPOSE OF REVIEW The review summarizes the epidemiology, risk factors, clinical presentation, diagnosis and management of the most important etiologic agents of infectious diarrhea in critically ill transplant recipients. RECENT FINDINGS Diarrhea, frequently caused by infectious pathogens, can cause significant morbidity and mortality in transplant recipients. Diarrhea can lead to severe dehydration, acute renal failure, medication toxicity, rejection, graft-versus-host disease and impairs patients' quality of life. Opportunistic infectious pathogens can pose significant diagnostic and therapeutic challenges in immunocompromised hosts. SUMMARY In transplant recipients, it is vital to differentiate infectious from noninfectious diarrhea to adequately manage their therapeutic approach. Supportive measures and reduction in immunosuppression are essential for the treatment management.
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21
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Gordon CA, Kurscheid J, Jones MK, Gray DJ, McManus DP. Soil-Transmitted Helminths in Tropical Australia and Asia. Trop Med Infect Dis 2017; 2:E56. [PMID: 30270913 PMCID: PMC6082059 DOI: 10.3390/tropicalmed2040056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022] Open
Abstract
Soil-transmitted helminths (STH) infect 2 billion people worldwide including significant numbers in South-East Asia (SEA). In Australia, STH are of less concern; however, indigenous communities are endemic for STH, including Strongyloides stercoralis, as well as for serious clinical infections due to other helminths such as Toxocara spp. The zoonotic hookworm Ancylostoma ceylanicum is also present in Australia and SEA, and may contribute to human infections particularly among pet owners. High human immigration rates to Australia from SEA, which is highly endemic for STH Strongyloides and Toxocara, has resulted in a high prevalence of these helminthic infections in immigrant communities, particularly since such individuals are not screened for worm infections upon entry. In this review, we consider the current state of STH infections in Australia and SEA.
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Affiliation(s)
- Catherine A Gordon
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
| | - Johanna Kurscheid
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Malcolm K Jones
- School of Veterinary Science, University of Queensland, Brisbane, QLD 4067, Australia.
| | - Darren J Gray
- Australian National University, Department of Global Health, Research School of Population Health, Australian Capital Territory 2601, Australia.
| | - Donald P McManus
- QIMR Berghofer Medical Research Institute, Molecular Parasitology Laboratory, Queensland 4006, Australia.
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