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Transpl Infect Dis. 2019 Feb;21(1):e13008. doi: 10.1111/tid.13008. Epub 2018 Oct 28.

Donor-derived strongyloidiasis after organ transplantation in Norway.

Author information

1
Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
2
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
3
Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway.
4
Department of Microbiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
5
Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway.
6
Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.
7
Regional Advisory Unit for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway.

Abstract

Strongyloides stercoralis is an intestinal helminth which in humans can cause asymptomatic chronic infection maintained for decades through its auto-infective cycle. During solid organ transplantation, recipients may unintentionally receive an organ infected with strongyloides. This is a very rare complication but may have deadly outcome if not detected. We hereby report two transplant recipients whom developed Strongyloides hyperinfection syndrome after organ transplantation from the same deceased donor. Recipient 1 was kidney transplanted and presented at day 65 post engraftment with diarrhea and subsequent septicemia and gastric retention. Larvae were detected in gastric aspirate. Recipient 2 was simultaneously kidney and pancreas transplanted and presented at day 90 post engraftment also with gastric retention and septicemia. Larvae were demonstrated on duodenal biopsy and stool sample. The clinical course was complicated with severe duodenal bleedings, gastric retention, meningitis, and prolonged hospitalization. Retrospective testing of pre-transplant donor serum was positive for Strongyloides stercoralis antibodies. As a result of disease severity and gastric retention albenazole was administered via a jejunal tube and ivermectin subcutaneously in both recipients. S stercoralis was successfully eradicated and the transplants ended up with unaffected graft function. Following these two cases, we started systematic screening of all deceased donors for serum Strongyloides IgG in October 2016. After having screened 150 utilized donors one tested positive for Strongyloides, which initiated prophylactic ivermectin treatment to organ recipients. No symptoms or disease developed. Our center will continue to screen all donors as prophylactic treatment may avert this potentially lethal complication in cases of donor-derived Strongyloides infection.

KEYWORDS:

Strongyloides stercoralis ; donor-derived infection; hyperinfection syndrome; pre-transplant screening; solid organ transplantation

PMID:
30295406
DOI:
10.1111/tid.13008
[Indexed for MEDLINE]

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