Abstract
Strongyloides stercoralis is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for Strongyloides stercoralis hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for Strongyloides stercoralis seropositivity by established ELISA testing. Positive Strongyloides stercoralis serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as Strongyloides infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some Strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not.
Highlights
Strongyloides stercoralis (S. stercoralis) is a parasite causing an enteric infection in animals and humans
This could predispose to S. stercoralis infections, since cyclosporine has a proven anthelmintic potential[15], while tacrolimus has no antiparasitic effect against S. stercoralis[16]
Out of 200 renal allograft recipients, six patients were tested positive for S. stercoralis infection with a cut off defined as patient extinction value divided by low infection reference value ≥1 (Fig. 1)
Summary
Strongyloides stercoralis (S. stercoralis) is a parasite causing an enteric infection in animals and humans. The frequently asymptomatic or nonspecific nature of active Strongyloides infection leads to underdiagnosis and places immunosuppressed patients at increased risk of developing hyperinfection and adverse outcome[7] It is a challenge for physicians who treat patients with immunosuppressive regimens such as allograft recipients, patients with autoimmune diseases and individuals after chemotherapy[8]. In this study we have chosen one of the tests currently available in Europe for 1) evaluating the prevalence of S. stercoralis infection and seropositivity among renal allograft recipients, 2) testing whether patients with migrant background are more frequently carriers of the parasite, 3) investigating the course of immunoglobulin G (IgG) signal over time post transplantation, while triple immunosuppressive therapy represents the standard of care and 4) following the antibody signal of the patient developing disseminated disease over years
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
