Strongyloides stercoralis_small bowel

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Time to detection: 
30 days - 10 months
Alerting signals, symptoms, evidence of occurrence: 
Case report 1: rhabditiform larvae found in stool of ostomy site and eosinophila; responsive to ivermectin. Case report 2: abdominal symptoms (nausea, vomiting, constipation) and fever. Small bowel and colon biopsies with Strongyloides stercoralis infestation. Respiratory symptoms with positive BAL for Strongyloides hyperinfection syndrome (SHS).
Demonstration of imputability or root cause: 
Case report 1: Recipient without contact history, negative pre-transplant stool sample and low eosinophil count until after detection of larvae. Donor had history of living in Phillipines and high eosinophilia. Heart, liver, kidney, and pancreas transplant recipients were not infected. No serological testing of either donor or recipient. Case report 2: Donor native of Honduras. Recipient without contact or travel history, no pretransplant eosinophilia. Parasite found in BAL and small bowel + colon biopsies. Responsive to ivermectin and thiabendazole. No available pretransplant donor or recipient serum.
Imputability grade: 
2 Probable
Suggest references: 
1) Strongyloides stercoralis infection in an intestinal transplant recipient. Hsu CN et al. Transpl Infect Dis. 15(4):E139-43, 2013 Aug. 2) Patel, G.; Arvelakis, A.; Sauter, B.V.; Gondolesi, G.E.; Caplivski, D.; Huprikar, S. Strongyloides hyperinfection syndrome after intestinal transplantation 2008; 10 (2) :37
clone of record 680: Strongyloides and SOT Record 1702 should be merged INTO this one please: suggest add keywords "ostomy" "asymptomatic infection" from case 1702; please also check the timing for the other one which was much sooner and add that to the timeframe --> OK done (EP)
Expert comments for publication: 
Risk mostly related to chronic intestinal Strongyloides infection. Rare transmission through transplant, reported in kidney, pancreas, intestine. Classical clinic: hyperinfection syndrome with worsening of pulmonary function, starting with wheezing and eventually progression to an ARDS–like picture, with respiratory failure and death. Many patients have concurrently gastrointestinal symptoms, including abdominal pain, dyspepsia, diarrhea, or constipation, or severe manifestations including ileus, obstruction and GI bleeding. Classical complication: gram-negative enteric bacteria sepsis, caused by larvae migrating from the bowel through the venous system (-> meningitis, cholecystitis, liver abscess, pancreatitis). Time of Onset: up to 9 months. Eosinophilia not always present. High mortality rate!