Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor

D. A. Roseman, D. Kabbani, Joann A. Kwah, D. Bird, R. Ingalls, A. Gautam, M. Nuhn, J. M. Francis

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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. The authors describe the course of acute strongyloidiasis in two kidney recipients transplanted from a single donor with evidence of donor transmission and discuss potential risk factors, treatment options, and implications for care providers.

Original languageEnglish (US)
Pages (from-to)2483-2486
Number of pages4
JournalAmerican Journal of Transplantation
Volume13
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Strongyloides stercoralis
Kidney Transplantation
Tissue Donors
Strongyloidiasis
Ivermectin
Immunosuppressive Agents
Allografts
Larva
Maintenance
Kidney
Lung
Immunocompromised Host
Centers for Disease Control and Prevention (U.S.)
Diarrhea
Stomach
Referral and Consultation
Transplantation
Biopsy
Mortality
Infection

Keywords

  • Donor-derived infection
  • hyperinfection syndrome
  • kidney transplantation
  • Strongyloides stercoralis

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor. / Roseman, D. A.; Kabbani, D.; Kwah, Joann A.; Bird, D.; Ingalls, R.; Gautam, A.; Nuhn, M.; Francis, J. M.

In: American Journal of Transplantation, Vol. 13, No. 9, 09.2013, p. 2483-2486.

Research output: Contribution to journalArticle

Roseman, DA, Kabbani, D, Kwah, JA, Bird, D, Ingalls, R, Gautam, A, Nuhn, M & Francis, JM 2013, 'Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor', American Journal of Transplantation, vol. 13, no. 9, pp. 2483-2486. https://doi.org/10.1111/ajt.12390
Roseman, D. A. ; Kabbani, D. ; Kwah, Joann A. ; Bird, D. ; Ingalls, R. ; Gautam, A. ; Nuhn, M. ; Francis, J. M. / Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor. In: American Journal of Transplantation. 2013 ; Vol. 13, No. 9. pp. 2483-2486.
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