title: Two donor-related infections in a heart transplant recipient: one common, the other a tropical surprise.
abstract: 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.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. j.brugemann@thorax.umcg.nl
authors.forename: Johan
authors.initials: J
authors.lastname: Brügemann
authors.forename: Greetje A
authors.initials: GA
authors.lastname: Kampinga
authors.forename: Annelies
authors.initials: A
authors.lastname: Riezebos-Brilman
authors.forename: Cari J
authors.initials: CJ
authors.lastname: Stek
authors.forename: Jan Pieter
authors.initials: JP
authors.lastname: Edel
authors.forename: Wim
authors.initials: W
authors.lastname: van der Bij
authors.forename: Herman G
authors.initials: HG
authors.lastname: Sprenger
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
mesh_terms: 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