133. Strongyloides stercoralis Infection Incidence, Risk Factors and Outcomes Among Solid Organ Transplant Candidates and Recipients; a Florida Center Experience
Session: Oral Abstract Session: Infections in Transplantation
Thursday, October 5, 2017: 11:15 AM
Room: 05AB
Background: Most infections of Strongyloides stercoralis are asymptomatic but can be fulminant in the immunosuppressed. Fatal infections in transplant patients have been reported in United States but incidence estimates are lacking.

Our protocol for Strongyloides until 2009 screened immigrants and those with travel history to endemic areas. In 2010, we began universal screening of SOT candidates due to a case of disseminated Strongyloidiasis in an unscreened lung transplant recipient with unknown risk factors. We calculated the incidence of Strongyloides stercoralis in our SOT candidates and associated risk factors, treatment, and outcomes since protocol change.

Methods: A retrospective review was performed of patients who underwent transplant evaluation from January 2014 to July 2016. Patients positive for Strongyloides stercoralis were reviewed for age, sex, ethnicity, place of birth, travel history, occupation, eosinophilia, treatment, and outcome. We report descriptive statistics.

Results: Of a total of 2351 SOT patients, 116 tested positive (Heart 33, Lung 24, Kidney 26, Liver 31, Pancreas 2) with an incidence of 4.9%. 113 charts were available for review. The characteristics of the patients are summarized in Table 1. Fifty patients had traditional risk factors (44%) and 63 lacked them (56%). Eosinophilia was present in 15% of cases. Of those transplanted, 87% received prophylaxis and none developed active Strongyloidiasis.

Conclusion: Our results show that Strongyloides stercoralis infection has a relatively high incidence in SOT patients and universal screening identified a substantial number that otherwise would go undetected, placing the transplant patient at risk of a fatal, yet preventable complication.

Table 1: Characteristics of Patients

 

Patient characteristics

 Number

 

%

Total Screened

2365

 

Positive Strongyloides

116

4.9

Age Group

60-70 yrs

50-59 yrs

40-49 yrs

< 40

 

41

23

22

27

 

36

20

19

24

Sex

Male

Female

 

90

23

 

80

20

Ethnicity

White

Hispanic

African American

 

81

18

14

 

72

16

12

Occupation with soil or water contact

21

19

Total SOT Patients

Treated before SOT

Ivermectin

Albendazole

38

33

32

1

 

87

97

3

Travel or birth outside US

Puerto Rico

Caribbean and South America

Middle East

Africa

Europe and Australia

Asia

35

12

10

3

2

3

5

 

31

34

29

8

6

8

14

Eosinophilia > 5%

17

15

 

Robert Castro, MD, Infectious Disease & International Medicine, University of South Florida College of Medicine, Tampa, FL, Sadaf Aslam, MD, Division of Infectious Diseases and International Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, Christopher Albers, MD, Tampa General Medical Group, Tampa, FL, Louise Gutierrez, MD, Infectious Diseases, University of South Florida, Tampa, FL, Marijesmar Gonzalez, MD, University of South Florida, Tampa, FL and Sally Alrabaa, MD, Infectious Diseases and International Medicine, University of South Florida, Tampa, FL

Disclosures:

R. Castro, None

S. Aslam, None

C. Albers, None

L. Gutierrez, None

M. Gonzalez, None

S. Alrabaa, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.