Donor-Derived Strongyloides stercoralis Infection in Two of Three Organ Transplant Recipients — California, Michigan, Ohio, 2022

  • Healthcare Acquired or Nosocomial Infections
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Infection with the soil-transmitted parasite Strongyloides stercoralis can cause severe complications among organ recipients. Not all organ procurement organizations (OPOs) test solid organ donors for Strongyloides infection. In December 2021, an OPO was notified of potential donor-derived infection in a right kidney recipient with strongyloidiasis confirmed 102 days posttransplant. The Organ Procurement and Transplantation Network Ad Hoc Disease Transmission Advisory Committee (DTAC) was notified of the possible event. CDC accepted the case for investigation to determine infection source.

CDC contacted the OPO to confirm the status of organs from the donor and obtain donor history and testing results; state health departments were notified of the case series investigation. To determine donor infection status, the OPO submitted a specimen for Strongyloides antibody testing. Transplant coordinators were interviewed about recipient Strongyloides testing, treatment, and risks. The DTAC case classification was used to determine case status.

The organ donor emigrated from a strongyloidiasis endemic region and worked in landscaping; the banked specimen tested positive for Strongyloides antibodies. The right kidney recipient was serologically negative pretransplant. She had gastrointestinal symptoms 98 days posttransplant. Small bowel and stomach biopsies revealed Strongyloides infection. The left kidney and heart recipients were not screened pretransplant. The left kidney recipient was born in an endemic region, resides in a rural area, and had no clinical illness compatible with strongyloidiasis; two posttransplant Strongyloides antibody tests were negative. The heart recipient had no known risks; bronchoalveolar lavage revealed Strongyloides infection. She developed disseminated strongyloidiasis and hyperinfection syndrome 131 days posttransplant. Based on results, donor-derived strongyloidiasis was proven in two of three recipients.

Testing donors whose histories suggest strongyloidiasis risk can help prevent donor-derived infections. Although testing donors for strongyloidiasis is not standard for all OPOs, increased testing can improve patient outcomes through preemptive treatment of transplant recipients.

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