Year: 2009
Type: article
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.The case reported here illustrates important features of infection with Strongyloides stercoralis and highlights several key aspects of hyperinfection syndrome: the specific vulnerability of transplant recipients to hyperinfection with this parasite, often decades after their initial exposure; high mortality among immunosuppressed patients; and diagnostic difficulties.In this article, we review the clinical aspects of Strongyloides infection in transplant recipients and provide specific recommendations regarding prevention, diagnosis, and treatment of Strongyloides hyperinfection syndrome. CASE REPORTA 63-year-old man was hospitalized for 5 months for severe heart failure, until he underwent heart transplantation.He had immigrated to the United States from Addis Ababa, Ethiopia, in 1979 at age 34 years and subsequently had never traveled to an area where strongyloidiasis was known to be endemic.Findings of a gastrointestinal evaluation (including colonoscopy) for constipation and anemia several years before transplantation were negative.
Source: Clinical Infectious Diseases
DOI: 10.1086/630201
Language: English
Subfield: Parasitology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W2171248503