1383. Universal Strongyloides Screening in a Heart Transplant Program in South Carolina: Just How Endemic Is It?

Abstract

Abstract Background Strongyloides stercoralis is endemic in sub-Saharan Africa, Southeast Asia, Latin America, and the southeastern United States, particularly Appalachia, where Strongyloides seroprevalence approaches 2%. SC is considered a state in which Strongyloides is endemic, however the degree of endemnicity is not known. Here we define the epidemiology of chronic strongyloidiasis in our state, through data obtained via universal screening of heart transplant candidates at our center. Methods This single center retrospective study was performed at a 700 bed academic medical center that is the only comprehensive transplant center in SC. All adult patients who underwent heart transplant evaluation 1/1/2019 - 12/31/2020 were included. Routine pre-transplant evaluation by Transplant Infectious Diseases (TxID) was implemented in the heart transplant program in 2015 and universal screening with Strongyloides IgG began in late 2018. We assessed demographics, risk factors for exposure to Strongyloides, treatment, and outcomes for seropositive subjects. Results During the study period, 218 patients underwent heart transplant evaluation. Adherence to universal screening was 96.8% (211/218). 187 subjects (88.6%) had negative screening results (≤ 0.9 IV) and 24 subjects (11.4%) had equivocal or positive screening results (≥ 1.0 IV). Demographics and risk factors for the 24 equivocal/positive subjects are presented in Table 1. 15 equivocal/positive subjects (66.7%) received ivermectin and 9 (33.3%) did not. The majority of untreated patients were declined for transplant (8/9) and did not have a TxID evaluation (6/9). One untreated patient was waitlisted for transplant and has received ivermectin since being identified in this study. There were no episodes of hyperinfection or disseminated infection in the cohort. Table 1. Demographics and risk factors for subjects with equivocal or positive Strongyloides IgG Conclusion Universal screening of adult heart transplant candidates at SC’s only transplant center detected a Strongyloides seroprevalence rate of 11.4%. The majority of subjects with equivocal/positive Strongyloides IgG were born in the US and did not have other known risk factors (residence in the Appalachian region of SC, military service, overseas travel). These data suggest a high level of endemnicity of strongyloidiasis in SC. Disclosures All Authors: No reported disclosures