Abstract
BackgroundSevere Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection.Methodology/Principal findingsThis was a retrospective, multicenter, case–control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5–965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05–18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2–7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001–1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46–2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83–35316.61).Conclusions/SignificanceSevere S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment.
Highlights
Infections due to the nematode Strongyloides stercoralis are endemic in many countries, and the most recent data suggest more than 300,000,000 patients are affected worldwide [1]
We have shown that severe S. stercoralis infection is still a relevant issue in kidney transplantation, with significant morbidity and mortality, especially when it occurs early after transplantation
Some of our findings could be translated to clinical practice to improve outcomes of severe S. stercoralis infection
Summary
Infections due to the nematode Strongyloides stercoralis are endemic in many countries, and the most recent data suggest more than 300,000,000 patients are affected worldwide [1]. The great majority of patients infected with S. stercoralis are asymptomatic or have only a few, mild clinical symptoms, a small proportion of such patients present with severe disease, manifesting either as hyperinfection syndrome or as disseminated disease [3,4]. Such infections mainly affect immunocompromised patients such as those on long-term corticosteroid therapy, those with AIDS, and organ transplant recipients [5,6]. Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, little is known about the risk factors for such infection
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