Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report
Abstract Background Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-trans...
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| Format: | Article |
| Language: | English |
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BMC
2020-08-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-020-05333-8 |
| _version_ | 1818305628355952640 |
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| author | Christina Lai Matthew Anderson Rebecca Davis Lyndal Anderson Kate Wyburn Steve Chadban David Gracey |
| author_facet | Christina Lai Matthew Anderson Rebecca Davis Lyndal Anderson Kate Wyburn Steve Chadban David Gracey |
| author_sort | Christina Lai |
| collection | DOAJ |
| description | Abstract Background Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-transplantation, resulting in significant morbidity and mortality. Here we present the first published case we are aware of, describing post-transplant Strongyloides hyperinfection in an HIV-positive kidney transplant patient. We discuss the diagnostic challenges and the role of pre-transplant screening. Case presentation A 58-year-old African-American male, originally from the Caribbean, received a deceased donor kidney transplant for presumed focal segmental glomerulosclerosis. He was known to be HIV-positive, with a stable CD4 count, and an undetectable viral load. Five months post-transplant, he developed gastrointestinal symptoms and weight loss. He had a normal eosinophil count (0.1–0.2 × 109/L), negative serum cytomegalovirus DNA, and negative blood and stool cultures. His Strongyloides serology remained negative throughout. A diagnosis of Strongyloides hyperinfection was made by the histological examination of his duodenum and lung, which identified the parasites. He completed his course of treatment with Ivermectin but exhibited profound deconditioning and required a period of total parenteral nutrition. He was subsequently discharged after a prolonged hospital admission of 54 days. Conclusions This case highlights the challenges in diagnosing Strongyloides infection and the need to maintain a high index of clinical suspicion. Non-invasive techniques for the diagnosis of Strongyloides may be insufficient. Routine pre-transplant serological strongyloidiasis screening is now performed at our centre. |
| first_indexed | 2024-12-13T06:29:37Z |
| format | Article |
| id | doaj.art-7407a46fe8d34799b7fae19a5ab92661 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-13T06:29:37Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-7407a46fe8d34799b7fae19a5ab926612022-12-21T23:56:39ZengBMCBMC Infectious Diseases1471-23342020-08-012011410.1186/s12879-020-05333-8Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case reportChristina Lai0Matthew Anderson1Rebecca Davis2Lyndal Anderson3Kate Wyburn4Steve Chadban5David Gracey6Department of Renal Medicine, RPA Transplantation Services, Royal Prince Alfred HospitalDepartment of Renal Medicine, RPA Transplantation Services, Royal Prince Alfred HospitalDepartment of Microbiology and Infectious Diseases, Royal Prince Alfred HospitalCentral Clinical School, Faculty of Medicine, University of SydneyDepartment of Renal Medicine, RPA Transplantation Services, Royal Prince Alfred HospitalDepartment of Renal Medicine, RPA Transplantation Services, Royal Prince Alfred HospitalDepartment of Renal Medicine, RPA Transplantation Services, Royal Prince Alfred HospitalAbstract Background Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-transplantation, resulting in significant morbidity and mortality. Here we present the first published case we are aware of, describing post-transplant Strongyloides hyperinfection in an HIV-positive kidney transplant patient. We discuss the diagnostic challenges and the role of pre-transplant screening. Case presentation A 58-year-old African-American male, originally from the Caribbean, received a deceased donor kidney transplant for presumed focal segmental glomerulosclerosis. He was known to be HIV-positive, with a stable CD4 count, and an undetectable viral load. Five months post-transplant, he developed gastrointestinal symptoms and weight loss. He had a normal eosinophil count (0.1–0.2 × 109/L), negative serum cytomegalovirus DNA, and negative blood and stool cultures. His Strongyloides serology remained negative throughout. A diagnosis of Strongyloides hyperinfection was made by the histological examination of his duodenum and lung, which identified the parasites. He completed his course of treatment with Ivermectin but exhibited profound deconditioning and required a period of total parenteral nutrition. He was subsequently discharged after a prolonged hospital admission of 54 days. Conclusions This case highlights the challenges in diagnosing Strongyloides infection and the need to maintain a high index of clinical suspicion. Non-invasive techniques for the diagnosis of Strongyloides may be insufficient. Routine pre-transplant serological strongyloidiasis screening is now performed at our centre.http://link.springer.com/article/10.1186/s12879-020-05333-8StrongyloidesStrongyloides hyperinfectionKidney transplantHuman immunodeficiency virusHIVCase report |
| spellingShingle | Christina Lai Matthew Anderson Rebecca Davis Lyndal Anderson Kate Wyburn Steve Chadban David Gracey Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report BMC Infectious Diseases Strongyloides Strongyloides hyperinfection Kidney transplant Human immunodeficiency virus HIV Case report |
| title | Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report |
| title_full | Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report |
| title_fullStr | Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report |
| title_full_unstemmed | Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report |
| title_short | Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report |
| title_sort | strongyloides hyperinfection in an hiv positive kidney transplant recipient a case report |
| topic | Strongyloides Strongyloides hyperinfection Kidney transplant Human immunodeficiency virus HIV Case report |
| url | http://link.springer.com/article/10.1186/s12879-020-05333-8 |
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