Multiple parasitic infections in a cardiac transplant recipient

• Published in: BMJ case reports Vol. 2015; p. bcr2014207033
• Main Authors: Sanches, Bruno Fernandes, Morgado, Joana, Carvalho, Nuno, Anjos, Rui
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 24.06.2015; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Abdominal Pain - parasitology; Adolescent; Albendazole - administration & dosage; Animals; Anthelmintics - administration & dosage; Asymptomatic; Black; Cardiac function; Cytomegalovirus; Diarrhea; Diarrhea - complications; Diarrhea - parasitology; Disease; Europe (West); Feces - parasitology; Female; Heart Transplantation; Heart transplants; Hospitalization; Humans; Infections; Ivermectin - administration & dosage; Kidney transplants; Liver; Medical prognosis; Mortality; Parasites; Pathogens; Patients; Praziquantel - administration & dosage; Schistosoma - isolation & purification; Schistosomiasis - complications; Schistosomiasis - diagnosis; Schistosomiasis - drug therapy; Strongyloides stercoralis - isolation & purification; Strongyloidiasis - complications; Strongyloidiasis - diagnosis; Strongyloidiasis - drug therapy; Transplant Recipients; Treatment Outcome; Unusual Association of Diseases/Symptoms; Viral infections; Vomiting; Vomiting - parasitology
• DOI: 10.1136/bcr-2014-207033
• ISSN: 1757-790X

Infectious complications represent an important cause of morbidity and death in patients with transplant. Parasitic infections are less frequent than viral and bacterial agents, and are often overlooked. We describe the case of a 13-year-old adolescent, born in São Tomé Island, who was under immunosuppressive therapy after a cardiac transplant. The patient had an intermittent course of diarrhoea, abdominal pain and vomiting. She was admitted dehydrated, and Strongyloides stercoralis, Schistosoma intercalatum and Cystoisospora belli were isolated in her stools. The patient was treated with ivermectin, albendazole, praziquantel and ciprofloxacin with clinical and microbiological resolution. Her immunosuppressive therapy was reduced during hospitalisation. We believe that the parasitic infection was a result of a recrudescence of dormant infections acquired in her homeland. To the best of our knowledge, there are no reports of cystoisosporiasis or schistosomiasis in heart transplant recipients.