Strongyloides stercolaris_Kidney Pancreas

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Time to detection: 
Two months
Alerting signals, symptoms, evidence of occurrence: 
Diarrhoea, weakness, and abdominal pain. Evidence by oesophago-gastroduodenoscopy revealing an oedematous and ulcerated mucosa of the duodenal bulb, as well as necrotic tissue. A biopsy of the first duodenal portion revealed an intense immune response caused by the presence of the parasite S. stercoralis. Stool samples were sent to the laboratory for microscopic observation and culture, resulting in the finding of rhabditiform larvae.
Demonstration of imputability or root cause: 
Donor’s serum was obtained from the biobank and analyzed by ELISA; the sample showed a positive titre for anti-Strongyloides (IgG) antibodies, thereby demonstrating the origin of the infection.
Imputability grade: 
2 Probable
Suggest references: 
1) Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation.Galiano A; Trelis M; Moya-Herraiz A; Sanchez-Plumed J; Merino JF.Int J Infect Dis. 51:19-21, 2016 Oct. 2) Real-Time Polymerase Chain Reaction in Stool Detects Transmission of Strongyloides stercoralis from an Infected Donor to Solid Organ Transplant Recipients. Gomez-Junyent J, et al. Am J Trop Med Hyg. 94(4):897-9, 2016 3) Strongyloides stercoralis infection in kidney transplant recipients.Abdalhamid BA, et al. Saudi J Kidney Dis Transpl. 26(1):98-102, 2015 4) Donor-Derived Strongyloidiasis Infection in Solid Organ Transplant Recipients: A Review and Pooled Analysis. [Review] Kim, J H, et al. Transplant Proc. 48(7):2442-2449, 2016 5) Strongyloides stercoralis in solid organ transplantation: early diagnosis gets the worm. Mobley CM, et al. Curr Opin Organ Transplant. 2017 Aug;22(4):336-344
5 papers on Strongy to be uploaded here for editorial work (Ines) 4 paper added - the review of Kim, J H et al is not available (EP)
Expert comments for publication: 
Donor from an endemic area of Strongyloides stercolaris should have been tested with serology and stool examination to discard infection. Even more when treatment is easy and effective with a single dose of ivermectine. Infection in the donor does not contraindicate transplantation but precludes treatment of the recipient in case the donor do not receive appropriate therapy