Strongyloidiasis in Solid Organ Transplantation

Abstract

Strongyloides stercoralis, an intestinal parasitic nematode (roundworm), infects more than 100 million people worldwide. While most infected immunocompetent persons are either asymptomatic or experience only mild, intermittent symptoms, immunosuppressed individuals, including those undergoing solid organ transplantation, are at increased risk for developing the frequently fatal hyperinfection syndrome. Donor-derived strongyloidiasis has recently become increasingly recognized and reported but current donor screening practices leave substantial room for improvement. Knowledge that available standard diagnostic tests have suboptimal performance characteristics has led to the development of newer diagnostic assays including use of polymerase chain reactions. Ivermectin has been considered the recommended therapeutic agent but current evidence suggests that it may be less effective than previously believed. Because of the increasing global performance of solid organ transplantation, together with the global presence of the parasite, this infection is of universal interest. While some management issues are yet to be resolved, fatal outcomes from Strongyloides hyperinfection syndrome can be prevented by appropriate pre-transplantation screening and treatment of the solid organ donor and/or the recipient.