Background: Solid Organ Transplant (SOT) recipients are at risk for Strongyloides stercoralis hyperinfection syndrome and disseminated disease. Most cases are caused by reactivation of latent infection in the recipients or through transmission from an infected donor. The purpose is to describe the demographic, clinical presentation, diagnoses and treatment of Strongyloides infection after SOT.

Methods:Three cases of Strongyloides were identified at our institution. We searched PubMed for English-language articles containing the terms “strongyloides,” and “transplant”. We collected their demographic data, type of transplant, clinical presentation, diagnosis and treatment.

Results: From January 2000 until November 2016, 52 cases of strongyloidiasis after SOT were identified: 49 published in the literature and 3 from our center. 58% were males with a median age of 49 (range 14-67) years. Transplanted organs were: kidney (32), heart (7), liver (6), intestine (2) and lung (1). 4 patients had combined transplants. 37% (17/47) patients received anti-thymocyte globulin (ATG) as induction immunosuppression or during rejection preceding infection. 25/52 (48%) cases were donor derived and 76% (40/52) of the cases had disseminated disease. Interestingly, some of cases occurred in non endemic areas. Only 9% had pretransplant strongyloides serology available. Patients presented with gastrointestinal (GI) or respiratory symptoms in 29% (15/52) and 27% (14/52) respectively, 7 patients had both symptoms and 8 presented with sepsis and/or meningitis. Fever was present in 47% of cases. 46% (15/32) had eosinophilia at onset of illness. The median time to diagnosis of strongyloides after SOT was 72 (14-2950) days. Strongyloides was isolated in 27 respiratory and in 23 GI specimens. 48% (25/52) of the patients died. 50% received combination therapy with albendazole or thiabendazole with ivermectin. Median duration of treatment was 14 days.

Discussion:This review shows the importance of screening the recipients/donors and diagnosis of Strongyloides prior to and after transplantation especially in endemic areas. The clinical symptoms are non specific and requires a high index of suspicion for diagnosis. The mortality rate in this group is high and early treatment is needed.

CITATION INFORMATION: El Haddad H, Hemmige V, Sofjan A, Lasco T, Restrepo A. Strongyloides Infection in Solid Organ Transplant Recipients: A Single Center Experience and Review of the Literature. Am J Transplant. 2017;17 (suppl 3).

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