Severe Strongyloidiasis in Solid Organ Transplant Recipients: Should We Preventively Treat the Recipient, the Donor, or Both?

Gilles Eperon Université Pierre et Marie Curie, Paris, France;
Service des Maladies Infectieuses et Tropicales, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;
Département de Médecine Communautaire, de Premier Recours et des Urgences, Service de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland;

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Jerome Tourret Université Pierre et Marie Curie, Paris, France;
Département d’Urologie, Néphrologie et Transplantation, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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Oana Ailioaie Université Pierre et Marie Curie, Paris, France;
Département d’Urologie, Néphrologie et Transplantation, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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Luc Paris Université Pierre et Marie Curie, Paris, France;
Laboratoire de Parasitologie-Mycologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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Lucile Mercadal Département d’Urologie, Néphrologie et Transplantation, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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Julien Mayaux Université Pierre et Marie Curie, Paris, France;
Assistance Publique–Hôpitaux de Paris, Service de Pneumologie et Réanimation médicale, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France

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Eric Caumes Université Pierre et Marie Curie, Paris, France;
Service des Maladies Infectieuses et Tropicales, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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Benoit Barrou Université Pierre et Marie Curie, Paris, France;
Département d’Urologie, Néphrologie et Transplantation, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière Charles Foix, Paris, France;

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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.

Author Notes

Address correspondence to Gilles Eperon, Département de Médecine Communautaire, de Premier Recours et des Urgences, Service de Médecine Tropicale et Humanitaire, HUG. Rue Gabrielle-Perret-Gentil 4, CH-1211 Genève 14, Switzerland, E-mail: gilles.eperon@hcuge.ch or Jerome Tourret, Département d’Urologie, Néphrologie et Transplantation, Groupe Hospitalier Pitié Salpêtrière Université Pierre et Marie Curie, 47-83 Bd de l’Hôpital, Paris, France, E-mail: jerome.tourret@aphp.fr.

These authors contributed equally to this work.

Authors’ addresses: Gilles Eperon, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, Service des Maladies Infectieuses et Tropicales, Hopital Pitie-Salpetriere, Paris, France, Department of Medicine, UPMC Faculte de Medecine, Paris, France, and Département de Médecine Communautaire, de Premier Recours et des Urgences, Service de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland, E-mail: gilles.eperon@hcuge.ch. Jerome Tourret and Benoit Barrou, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, Département d'Urologie, Néphrologie et Transplantation, Hopital Pitie-Salpetriere, Paris, France, and Department of Medicine, UPMC Faculte de Medecine, Paris, France, E-mails: jerome.tourret@aphp.fr and benoit.barrou@aphp.fr. Oana Ailioaie and Lucile Mercadal, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, and Département d’Urologie, Néphrologie et Transplantation, Hopital Pitie-Salpetriere, Paris, France, E-mails: oana_ramayana@yahoo.com and lucile.mercadal@aphp.fr. Luc Paris, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, Laboratoire de Parasitologie et de Mycologie, Hopital Pitie-Salpetriere, Paris, France, and Department of Medicine, UPMC Faculte de Medecine, Paris, France, E-mail: luc.paris@aphp.fr. Julien Mayaux, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, and Service de Réanimation Médicale, Hopital Pitie-Salpetriere, Paris, France, E-mail: julien.mayaux@aphp.fr. Eric Caumes, Assistance Publique–Hopitaux de Paris, APHP, Paris, France, Service des Maladies Infectieuses et Tropicales, CHU Pitié Salpêtrière, Paris, France, and Department of Medicine, UPMC Faculte de Medecine, Paris, France, E-mail: eric.caumes@psl.aphp.fr.

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