title: Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor.
abstract: Strongyloides stercoralis hyperinfection in an immunocompromised host has a high mortality rate but may initially present with nonspecific pulmonary and gastrointestinal symptoms. Donor-derived S. stercoralis by kidney transplantation is an uncommon diagnosis and difficult to prove. We report two renal allograft recipients on different immunosuppressive maintenance regimens that developed strongyloidiasis after transplantation from the same donor. Recipient 1 presented with a small bowel obstruction. Larvae were demonstrated on a duodenal biopsy and isolated from gastric, pulmonary, and stool samples. Serologic testing for S. stercoralis was negative at a referral laboratory but positive at the Centers for Disease Control. The patient's hospital course was complicated by a hyperinfection syndrome requiring subcutaneous ivermectin due to malabsorption. Recipient 1 survived but the allograft failed. Recipient 2 had larvae detected in stool samples after complaints of diarrhea and was treated. On retrospective testing for S. stercoralis, pretransplant serum collected from the donor and Recipient 1 was positive and negative, respectively. Donor-derived strongyloidiasis by renal transplantation is a preventable disease that may be affected by the immunosuppressive maintenance regimen. Subcutaneous ivermectin is an option in the setting of malabsorption. Finally, routine screening for S. stercoralis infection in donors from endemic areas may prevent future complications.
authors.affiliation: Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA.
authors.forename: D A
authors.initials: DA
authors.lastname: Roseman
authors.forename: D
authors.initials: D
authors.lastname: Kabbani
authors.forename: J
authors.initials: J
authors.lastname: Kwah
authors.forename: D
authors.initials: D
authors.lastname: Bird
authors.forename: R
authors.initials: R
authors.lastname: Ingalls
authors.forename: A
authors.initials: A
authors.lastname: Gautam
authors.forename: M
authors.initials: M
authors.lastname: Nuhn
authors.forename: J M
authors.initials: JM
authors.lastname: Francis
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007559:Ivermectin / Q000008:administration & dosage / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008286:Malabsorption Syndromes; D008297:Male; D008875:Middle Aged; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000009:adverse effects; D000077562:Valganciclovir
chemical_list: D007559:Ivermectin; D015766:Albendazole; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Donor-derived infection; Strongyloides stercoralis; hyperinfection syndrome; kidney transplantation
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