Status:
Ready to upload
Record number:
2006
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Exact frequency unkown and it will vary depending on local epidemiology. See comments below.
Time to detection:
Three years after transplantation
Alerting signals, symptoms, evidence of occurrence:
Diarrhea and eosinophilia, following treatement for chronic rejeaction. S. stercoralis seen in stool microscopy. A review of her history and previous investigations revealed recurrent episodes of diarrhea and mild abdominal pain along with peripheral eosinophilia of 15%‐20% of her total WBC count for 1 year prior to diagnosis. Treated with repeated, prolonged course of Albendazole as Ivermectin is not a treatment option in Saudi Arabia.
Demonstration of imputability or root cause:
Epidemiological suspicion as the donor was from an endemic area (Indian subcontinent) and the recipient did not have any risk of exposure to Strongyloides spp.
Imputability grade:
1 Possible
Groups audience:
Keywords:
Suggest new keywords:
Strongyloides stercoralis, pediatric kidney transplantation, donor screening, endemic area
Reference attachment:
Suggest references:
Alsager K, et al. Donor-derived strongyloidiasis in a Saudi pediatric kidney transplant recipient: A case report and mini-review.Pediatr Transplant. 2018 Dec 21:e13315.
Abdalhamid BA, Al Abadi AM, Al Saghier MI, Joudeh AA, Shorman MA, Amr SS. Strongyloides stercoralis infection in kidney transplant recipients. Saudi J Kidney Dis Transpl 2015;26:98-102
Note:
re-edited. Will keep it short as there other cases (where imputability may be clearer) where more detailed comments need to appear. Ines
Expert comments for publication:
Strongyloidiasis is uncommon in SOT recipients in non-endemic areas. When it occurs, it is linked to reactivation in the recipient or more infrequently, it can be donor-derived. A clear epidemiological link can be established in terms of risk of exposure in endemic areas. Serology can be performed pre-transplant, (or immediately post-transplant in the case of decease organ donation) where a risk is identified, so that treatment can be instituted before transplantation. Highest risk with Strongyloides hyperinfection and in association with HTLV -1 inefction.