1213. Donor-derived Strongyloides stercoralis Infection in a Kidney/Pancreas Recipient, 2014: Evidence of the Need for Targeted Donor Screening
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek_final_version.pdf (507.7 kB)
  • Background: From 2009 to 2013, Centers for Disease Control and Prevention assisted with seven investigations of donor-derived infection. Eleven recipients developed strongyloidiasis, two of whom died. None of the seven donors were screened for Strongyloides antibody despite epidemiologic risk factors. Donor-derived Strongyloides stercoralis infection is a public health concern among solid-organ transplant (SOT) recipients and may lead to fatal outcomes as a result of hyperinfection syndrome and disseminated disease. To prevent these infections the American Society of Transplantation (AST) recommends that evaluation for strongyloidiasis be strongly considered in donors with epidemiologic risk factors or unexplained eosinophilia. Positive donor test results reported to transplant centers by organ procurement organizations (OPOs) allow for pre-emptive treatment and prevention of strongyloidiasis in SOT recipients. However, not all OPOs follow these recommendations.

    Methods:

    We describe the presentation of a SOT recipient who developed strongyloidiasis and the investigation that led to the determination of donor-derived infection. We assess the outcomes of this investigation based on AST’s guidelines.

    Results:

    Disseminated strongyloidiasis and Klebsiella bacteremia were diagnosed in a 36-year old male 5 weeks after kidney/pancreas transplantation. The recipient had no known risk factors for strongyloidiasis and pre-transplant serum was negative for Strongyloides antibody. Both organs were removed as a result of complications from this infection. The serum of the Mexico-born donor, tested after the recipient’s diagnosis, was positive. AST’s guidelines were not followed in this case. Five additional organs from this donor were transplanted in four recipients, all of whom received pre-emptive therapy with ivermectin and showed no evidence of infection after therapy, when evaluated 2-3 months post-transplant.

    Conclusion:

    Donor-derived strongyloidiasis is a serious and potentially fatal infection in SOT recipients. This case is an example of the adverse outcomes that may result when targeted donor screening is not conducted. When screening guidelines are adhered to, targeted screening and provision of pre-emptive therapy may prevent donor-derived strongyloidiasis.

    Francisca Abanyie, MD, MPH, Parasitic Diseases, CDC, Atlanta, GA, Kristin Delli Carpini, MPH, LiveOnNY, New York, NY, Elizabeth B. Gray, MPH, CDC, Atlanta, GA, Peter Chin-Hong, MD, Division of Infectious Diseases, University of California, San Francisco, San Francisco, CA, Jennifer C Ling, MD, California Pacific Medical Center, San Francisco, CA, Shirish Huprikar, MD, Icahn School of Medicine at Mount Sinai, New York, NY and Susan Montgomery, DVM, MPH, Parasitic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    F. Abanyie, None

    K. Delli Carpini, None

    E. B. Gray, None

    P. Chin-Hong, None

    J. C. Ling, None

    S. Huprikar, None

    S. Montgomery, None

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