Donor-derived Strongyloides stercoralis hyperinfection syndrome after simultaneous kidney/pancreas transplantation

• Published in: International journal of infectious diseases Vol. 51; no. C; pp. 19 - 21
• Main Authors: Galiano, A., Trelis, M., Moya-Herráiz, Á., Sánchez-Plumed, J., Merino, J.F.
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.10.2016; Elsevier
• Subjects: Adult; Animals; Donor-derived; Humans; Hyperinfection; Immunosuppression - adverse effects; Ivermectin - therapeutic use; Kidney; Kidney Transplantation - adverse effects; Male; Pancreas; Pancreas Transplantation - adverse effects; Strongyloides; Strongyloides stercoralis; Strongyloidiasis - diagnosis; Strongyloidiasis - etiology; Tissue Donors; Transplant; Hyperinfection; Strongyloides; Pancreas; Donor-derived; Kidney; Transplant
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2016.08.014

•Solid organ transplants are associated with immunosuppressive therapy. A latent infection can be reactivated. The recipient in this case originated from the Spanish Mediterranean Coast, which is considered an endemic focus of strongyloidiasis, and although there is no active transmission of the disease today, it could have resulted from working in the field or contact with soil. A history of travel to the tropics is also considered a risk factor and was present in this case patient.•Donor-derived infections are increasingly frequent in industrialized countries. Immigrants with undiagnosed chronic infections coming from endemic or hyperendemic areas may become donors.•In the case presented here, no specific parasitological or serological diagnostic tests were performed, despite the fact that the recipient (from Valencia, Spain) and the donor (from Bolivia, and positive for Toxoplasma gondii and Trypanosoma cruzi) originated from endemic areas. It was later confirmed by serology that the source of infection was the donor. If this test had been included among those performed pre-transplantation, this serious complication could have been avoided.•It is essential that the current Spanish practice guidelines are updated to include immunological (antibodies in serum) or molecular (antigen or DNA in faeces) techniques for screening pre-transplantation, and empirical treatment with ivermectin should be considered when diagnostic test information is not available on time. Most cases of strongyloidiasis associated with solid organ transplantation have been due to the reactivation of a latent infection in the recipient as a result of the immunosuppressive therapy; however, donor-derived infections are becoming increasingly frequent. The case of a patient who nearly died of a Strongyloides stercoralis hyperinfection after receiving simultaneous kidney/pancreas transplants is described herein. No specific parasitological tests were performed pre-transplantation, despite the fact that both the recipient and the donor originated from endemic areas. Serological analysis of the donor's serum performed retrospectively revealed the origin of the infection, which if it had been done beforehand would have prevented the serious complications. Current practice guidelines need to be updated to incorporate immunological and molecular techniques for the rapid screening of Strongyloides prior to transplantation, and empirical treatment with ivermectin should be applied systematically when there is the slightest risk of infection in the donor or recipient.