Strongyloidiasis in transplant patients

Abstract

Strongyloides stercoralis is an intestinal nematode that can persist in the human host for decades after the initial infection and can progress to fulminant hyperinfection syndrome in immunocompromised hosts. We describe a patient who died of Strongyloides hyperinfection syndrome 2 months after orthotopic heart transplantation and discuss approaches to prevention, diagnosis, and treatment. Current practice guidelines recommend screening for and treatment of Strongyloides infection before transplantation, but physicians in the United States often miss opportunities to identify patients with chronic strongyloidiasis. Screening tests have limitations, and clinical suspicion remains an important component of the evaluation before transplantation. After immunocompromised patients develop hyperinfection syndrome, diagnosis is often delayed and mortality is high, so emphasis must be placed on screening and treatment before transplantation. We review current strategies for prevention, diagnosis, and treatment of chronic intestinal strongyloidiasis in patients who will undergo transplantation and discuss the clinical features and management of Strongyloides hyperinfection syndrome in transplant recipients.

Figure 1

Chest radiograph (A) and computed tomography scan (B) at the time of diagnosis of Strongyloides hyperinfection syndrome. C, Microscopic image of the sputum wet mount examination. D, Sputum culture chocolate agar plate demonstrating serpentine bacterial trails.

Figure 2

Life cycle of Strongyloides stercoralis. Used with permission from the Centers for Disease Control and Prevention, Division of Parasitic Diseases.