Strongyloides stercoralis Transmission by Kidney Transplantation in Two Recipients From a Common Donor.

TitleStrongyloides stercoralis Transmission by Kidney Transplantation in Two Recipients From a Common Donor.
Publication TypeJournal Article
Year of Publication2013
AuthorsRoseman D., Kabbani D., Kwah J., Bird D., Ingalls R., Gautam A., Nuhn M., Francis J.
Journal//Am J Transplant
Pagination2483 - 2486
Date Published2013
ISBN Number1600-6135
Other Numbers100968638
KeywordsDonor-derived infection, Hyperinfection syndrome, Kidney Transplantation, Strongyloides stercoralis

: Strongyloides stercoralis hyperinfection in an immunocompromised host has a high mortality rate but may initially present with nonspecific pulmonary and gastrointestinal symptoms. Donor-derived S. stercoralis by kidney transplantation is an uncommon diagnosis and difficult to prove. We report two renal allograft recipients on different immunosuppressive maintenance regimens that developed strongyloidiasis after transplantation from the same donor. Recipient 1 presented with a small bowel obstruction. Larvae were demonstrated on a duodenal biopsy and isolated from gastric, pulmonary, and stool samples. Serologic testing for S. stercoralis was negative at a referral laboratory but positive at the Centers for Disease Control. The patient's hospital course was complicated by a hyperinfection syndrome requiring subcutaneous ivermectin due to malabsorption. Recipient 1 survived but the allograft failed. Recipient 2 had larvae detected in stool samples after complaints of diarrhea and was treated. On retrospective testing for S. stercoralis, pretransplant serum collected from the donor and Recipient 1 was positive and negative, respectively. Donor-derived strongyloidiasis by renal transplantation is a preventable disease that may be affected by the immunosuppressive maintenance regimen. Subcutaneous ivermectin is an option in the setting of malabsorption. Finally, routine screening for S. stercoralis infection in donors from endemic areas may prevent future complications., (C) 1999?2012 John Wiley & Sons, Inc

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