Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012-2017)

Mohanad Al-Obaidi, Rodrigo Hasbun, Karen J. Vigil, Angelina R. Edwards, Violeta Chavez, David R. Hall, Wasim A. Dar, Aleksandra De Golovine, Luis Ostrosky-Zeichner, John S. Bynon, Masayuki Nigo

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center. Methods: Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed. Results: A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P <. 05). In multivariate analysis, eosinophilia (P =. 01), diabetes mellitus (P =. 02), and Asian race (P =. 03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation. Conclusions: We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation.

Original languageEnglish (US)
Article numberofz172
JournalOpen Forum Infectious Diseases
Volume6
Issue number7
DOIs
StatePublished - Jul 1 2019

Keywords

  • kidney transplant candidate
  • pretransplant screening
  • strongyloidiasis

ASJC Scopus subject areas

  • Oncology
  • Infectious Diseases

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