Endemic Parasitic Disease - Expert Group Opinion for South Asia for Solid-Organ Transplantation − Leishmaniasis, Malaria, Toxoplasmosis, Filariasis, and Strongyloidiasis

Abstract

Although parasitic infections including malaria, leishmania, and toxoplasmosis contribute to a significant burden of the morbidity and mortality of global populations, they remain woefully understudied in solid-organ transplantation with recommendations mainly based on expert opinions. This paradox is due to the fact that the geographic prevalence of most of these infections is restricted to the developing world where priorities of care are different due to economic constraints. Limited availability of transplant programs where parasitic infections are endemic, challenges in diagnosis, re-activation or recrudescence of latent infections which may present at a later date, the lesser impact of these infections in the immune-suppressed host and limited availability of drugs used in the treatment of some of these infections may influence therapeutic interventions. In the Indian sub-continent, malaria, visceral leishmaniasis (VL), filariasis, strongyloidiasis, and toxoplasmosis are endemic. India contributes to 4% of the total global burden of cases of malaria and has the highest number of cases among the South Asian countries. VL is restricted to Bihar and West Bengal in India and liposomal amphotericin, the drug of choice is still prohibitively expensive. The impact of toxoplasmosis, filariasis, and strongyloidiasis in solid-organ transplant is still limited compared to other infections. Challenges are mainly related to donor screening and exclusion as applying western recommendations to these endemic infections may not be practical. Early diagnosis and appropriate therapy improve outcomes.