Strongyloides stercoralis is an intestinal nematode found in tropical, subtropical regions of the world and Southeastern United States including the Appalachian region. South Florida has a large population of immigrants from areas endemic for S. stercoralis. Seroprevalence of infection among solid organ transplant (SOT) candidates and potential donors in this region is unknown. By characterization of this population, we aim to increase awareness and optimize screening.
Methods: Retrospective study conducted among SOT candidates seen at the Miami Transplant Institute/Jackson Memorial Hospital between September 2014 to July 2015. Demographic information of SOT and potential donor candidates at the time of evaluation in pre-transplant clinic was collected. Screening of patients was done with commercially available ELISA kits (Bordier). Country of origin, symptoms, eosinophil count, association with HIV & HTLV were obtained. Descriptive statistics were calculated after analyzing variables.
53 (11%) patients of 498 screened were S. stercoralis seropositive. Mean age was 54, with male predominance (66%). On classification by country of origin, 14 (26%) were US born and 37(69.8%) foreign-born. Among the foreign-born, the majority were from the Caribbean (43%) followed by Central America (17%) and South America (13%). On clinical presentation, 70% were asymptomatic, 24% had symptoms from pre-existing organ failure and only 2% had complaints of intermittent diarrhea. Co-infection with HIV was seen in 2% of patients, and co-infection with HTLV was present in 6%. The majority of patients (76%) had normal eosinophil counts.
Of the 53 seropositive patients, 90% were SOT candidates and 10% were potential donors. 29 (55%) were treated with ivermectin. All these patients (29) were treated by transplant infectious disease doctors. 15% received transplants after completion of treatment (43% Heart, 28% Renal, 28% Other)
Based on characteristics in this population, all pre-transplant patients should be screened regardless of country of origin, symptoms, HIV or HTLV status and eosinophilia. Pre-transplant assessment with an Infectious Disease consultant may increase the likelihood for a seropositive patient to receive treatment.
J. Simkins, None
P. Lichtenberger, None
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