Two donor-related infections in a heart transplant recipient: one common, the other a tropical surprise.
BACKGROUND
Infection is the most frequent complication after heart transplantation (HTx). In this report and brief literature review we present a recipient who some 6 weeks post-HTx had two donor-related infections: a "common" primary cytomegalovirus (CMV) infection and, simultaneously, a highly unusual donor-related Strongyloides stercoralis infection.


METHODS
The parasite was discovered by chance in a skin biopsy. CMV was treated with ganciclovir and the strongyloidiasis was cured with two courses of anti-helminthic therapy--initially with ivermectine and albendazol and, in response to eosinophilia, with ivermectine monotherapy. The patient's recovery was further complicated by two successive rejection episodes, a relapse of the CMV syndrome and a novel influenza A/H1N1 infection. These episodes were treated with steroids, ganciclovir and oseltamivir, respectively.


RESULTS
It took almost 9 months before a permanent IgG anti-CMV response was seen. At 13 months post-HTx, coronary angiography showed only slight vessel wall abnormalities. At present, the patient is back at home and in good condition.


CONCLUSIONS
Until now, only 4 recipient-derived strongyloidiasis cases have been described in post-HTx patients, all diagnosed by autopsies. This is the first report of a donor-related Strongyloides infection in a patient after HTx.
Brügemann
Johan
J
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. j.brugemann@thorax.umcg.nl
Kampinga
Greetje A
GA
Riezebos-Brilman
Annelies
A
Stek
Cari J
CJ
Edel
Jan Pieter
JP
van der Bij
Wim
W
Sprenger
Herman G
HG
Zijlstra
Felix
F
D000328:Adult; D000818:Animals; D003586:Cytomegalovirus Infections / Q000209:etiology*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012867:Skin / Q000469:parasitology; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000209:etiology*; D014019:Tissue Donors