Volume 98, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Strongyloidiasis is caused by a soil-transmitted helminth that is endemic in tropical and subtropical countries. The parasite can complete its life cycle without leaving the host, allowing autoinfection and persistence. The risk of infection in travelers is low, but the disease may become lethal following immunosuppression. In case of solid organ transplantation, the risk of donor transmission has been suspected for several years. However, the management of live donors in this context has only recently been considered, and no guidelines exist for the management of deceased donors. To highlight the complexity of diagnosing, treating, and preventing strongyloidiasis donor transmission, we describe a case of possible transmission of severe strongyloidiasis to a kidney transplant recipient with limited travel history. Taking into account the difficulty of diagnosing chronic strongyloidiasis infection and the increase in travel and immunosuppressive treatments, we recommend pragmatic management guidelines to limit the risks of infection.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Marcos LA, Terashima A, Dupont HL, Gotuzzo E, , 2008. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg 102: 314318. [Google Scholar]
  2. Grapsa D, Petrakakou E, Botsoli-Stergiou E, Mikou P, Athanassiadou P, Karkampasi A, Ioakim-Liossi A, , 2009. Strongyloides stercoralis in a bronchial washing specimen processed as conventional and Thin-Prep smears: report of a case and a review of the literature. Diagn Cytopathol 37: 903905. [Google Scholar]
  3. Valerio L, Roure S, Fernandez-Rivas G, Basile L, Martinez-Cuevas O, Ballesteros AL, Ramos X, Sabria M, , 2013. Strongyloides stercoralis, the hidden worm. Epidemiological and clinical characteristics of 70 cases diagnosed in the North Metropolitan Area of Barcelona, Spain, 2003–2012. Trans R Soc Trop Med Hyg 107: 465470. [Google Scholar]
  4. Angheben A, Mistretta M, Gobbo M, Bonafini S, Iacovazzi T, Sepe A, Gobbi F, Marocco S, Rossanese A, Bisoffi Z, , 2011. Acute strongyloidiasis in Italian tourists returning from southeast Asia. J Travel Med 18: 138140. [Google Scholar]
  5. Gill GV, Bell DR, , 1979. Strongyloides stercoralis infection in former far east prisoners of war. BMJ 2: 572574. [Google Scholar]
  6. Nuesch R, Zimmerli L, Stockli R, Gyr N, Christoph Hatz FR, , 2005. Imported strongyloidosis: a longitudinal analysis of 31 cases. J Travel Med 12: 8084. [Google Scholar]
  7. Soonawala D, Lieshout LV, den Boer MA, Claas EC, Verweij JJ, Godkewitsch A, Ratering M, Visser LG, , 2014. Post-travel screening of asymptomatic long-term travelers to the tropics for intestinal parasites using molecular diagnostics. Am J Trop Med Hyg 90: 835839. [Google Scholar]
  8. UNWTO, 2014. Tourism Highlights. Madrid, Spain: World Tourism Organization.
  9. Ostera G, Blum J, Cornejo C, Burgula S, Jeun R, Bryan PE, Mejia R, , 2017. Strongyloidiasis in Latin American immigrants: a pilot study. J Helminthol 91: 262266. [Google Scholar]
  10. Hochberg NS, 2011. High prevalence of persistent parasitic infections in foreign-born, HIV-infected persons in the United States. PLoS Negl Trop Dis 5: e1034. [Google Scholar]
  11. Salluh JI, Bozza FA, Pinto TS, Toscano L, Weller PF, Soares M, , 2005. Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease? Braz J Infect Dis 9: 419424. [Google Scholar]
  12. Mejia R, Nutman TB, , 2012. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 25: 458463. [Google Scholar]
  13. Levi ME, 2014. Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy. Am J Transplant 14: 10031011. [Google Scholar]
  14. Roxby AC, Gottlieb GS, Limaye AP, , 2009. Strongyloidiasis in transplant patients. Clin Infect Dis 49: 14111423. [Google Scholar]
  15. Said T, 2007. Hyperinfection strongyloidiasis: an anticipated outbreak in kidney transplant recipients in Kuwait. Transplant Proc 39: 10141015. [Google Scholar]
  16. Roseman DA, Kabbani D, Kwah J, Bird D, Ingalls R, Gautam A, Nuhn M, Francis JM, , 2013. Strongyloides stercoralis transmission by kidney transplantation in two recipients from a common donor. Am J Transplant 13: 24832486. [Google Scholar]
  17. Hamilton KW, 2011. Donor-derived Strongyloides stercoralis infections in renal transplant recipients. Transplantation 91: 10191024. [Google Scholar]
  18. Mansfield LS, Alavi A, Wortman JA, Schad GA, , 1995. Gamma camera scintigraphy for direct visualization of larval migration Ln Strongyloides stercoralis-infected dogs. Am J Trop Med Hyg 52: 236240. [Google Scholar]
  19. Bon B, Houze S, Talabani H, Magne D, Belkadi G, Develoux M, Senghor Y, Chandenier J, Ancelle T, Hennequin C, , 2010. Evaluation of a rapid enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis. J Clin Microbiol 48: 17161719. [Google Scholar]
  20. Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, , 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ 171: 479484. [Google Scholar]
  21. Sudarshi S, Stumpfle R, Armstrong M, Ellman T, Parton S, Krishnan P, Chiodini PL, Whitty CJ, , 2003. Clinical presentation and diagnostic sensitivity of laboratory tests for Strongyloides stercoralis in travellers compared with immigrants in a non-endemic country. Trop Med Int Health 8: 728732. [Google Scholar]
  22. Segarra-Newnham M, , 2007. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother 41: 19922001. [Google Scholar]
  23. Turner SA, Maclean JD, Fleckenstein L, Greenaway C, , 2005. Parenteral administration of ivermectin in a patient with disseminated strongyloidiasis. Am J Trop Med Hyg 73: 911914. [Google Scholar]
  24. Centers for Disease Control and Prevention, IDSoA, American Society of Blood and Marrow Transplantation, 2000. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 49: 1125, CE1–7. Erratum in: MMWR Recomm Rep 2004;53. [Google Scholar]
  25. Muennig P, Pallin D, Challah C, Khan K, , 2004. The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States. Epidemiol Infect 132: 10551063. [Google Scholar]

Data & Media loading...

  • Received : 23 Mar 2017
  • Accepted : 26 Sep 2017
  • Published online : 22 Jan 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error