Investigation of donor‐derived Strongyloides stercoralis infection in multiple solid organ transplant recipients—California, Michigan, Ohio, 2022

• Published in: Transplant infectious disease 2023-06, Vol.25 (3), p.e14059-n/a
• Main Authors: Adeyemo, AdeSubomi, Montgomery, Susan, Chancey, Rebecca J., Annambhotla, Pallavi, Barba, Lilly, Clarke, Tyan, Williams, Jonathan, Malilay, Anne, Coyle, Joseph
• Format: Article
• Language: English
• Subjects: Algorithms; Alveoli; Animals; Antibodies; Biopsy; California; Chronic infection; Disease control; Disease transmission; donor‐derived; Female; Health services; Humans; Infections; Kidneys; Lavage; Michigan; Ohio; Organ donors; Organ Transplantation - adverse effects; Parasites; Parasitic diseases; parasitic infection; Risk factors; Serology; Small intestine; Strongyloides; Strongyloides stercoralis; Strongyloidiasis; Strongyloidiasis - diagnosis; Strongyloidiasis - drug therapy; Strongyloidiasis - parasitology; Tissue Donors; transplant
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.14059

Background The Centers for Disease Control and Prevention led an investigation to determine if Strongyloides infection in a right kidney recipient was an existing chronic infection, or if the infection was transmitted from an infected organ donor. Methods Evidence regarding the organ donor and organ recipients Strongyloides testing, treatment, and risk factors were gathered and evaluated. The case classification algorithm created by the Disease Transmission Advisory Committee was utilized. Results The organ donor had risk factors for Strongyloides infection; the banked donor specimen, submitted for serology testing 112 days post‐donor death, was positive. The right kidney recipient was negative for Strongyloides infection pretransplant. Strongyloides infection was diagnosed via small bowel and stomach biopsies. The left kidney recipient had risk factors for Strongyloides infection. Two posttransplant Strongyloides antibody tests were negative at 59 and 116 days posttransplant; repeat antibody tests returned positive at 158 and 190 days posttransplant. Examination of bronchial alveolar lavage fluid collected 110 days posttransplant from the heart recipient showed a parasite morphologically consistent with Strongyloides species. She subsequently developed complications from Strongyloides infection, including hyperinfection syndrome and disseminated strongyloidiasis. Based on the evidence from our investigation, donor‐derived strongyloidiasis was suspected in one recipient and proven in two recipients. Conclusion The results of this investigation support the importance of preventing donor‐derived Strongyloides infections by laboratory‐based serology testing of solid organ donors. Donor positive testing results would direct the monitoring and treatment of recipients to avoid severe complications. Donor‐derived Strongyloides infections can be prevented by serology testing of solid organ donors. A policy proposal that requires screening of all deceased organ donors is being considered. Donor positive testing results would not delay or prevent transplant; it would direct the monitoring and treatment of recipients to avoid severe complications.