Transplant infectious disease : an official journal of the Transplantation Society
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Review Case Reports
Strongyloides stercoralis hyperinfection syndrome after liver transplantation: case report and literature review.
Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection. Strongyloides infection may be asymptomatic for years, owing to a low parasite load. ⋯ In this specific circumstance, it can become a fatal illness. We describe a case of hyperinfection syndrome in a liver transplant recipient and also review the literature.
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Abstract: Strongyloides stercoralis is endemic in tropical, subtropical, and even temperate regions, and infects up to 100 million people worldwide. The diagnosis of strongyloidiasis can be difficult because of intermittent larval output in stool and nonspecific symptoms with mild peripheral eosinophilia. ⋯ Strongyloidiasis should be considered in immunocompromised patients from endemic areas who have unexplained peripheral eosinophilia. If screening tests are positive for S. stercoralis or if a patient has unexplained eosinophilia with even a remote history of travel to or residence in endemic areas, then ivermectin should be given before HSCT to prevent often fatal hyperinfection syndrome from occurring after HSCT.
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Hepatitis B virus (HBV) has been transmitted by tissue transplantation. In order to reduce the risk of HBV transmission, testing for antibody to HBV core antigen (anti-HBc) is used in addition to testing for hepatitis B surface antigen (HBsAg) in many blood centers and tissue banks. ⋯ We consider that anti-HBc and NAT assays must both still be performed in addition to HBsAg assay for HBV screening in tissue donors. All these tests will be useful in order to define an algorithm for safe and efficient management of the tissue bank.
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Newer immunosuppressive strategies have resulted in a marked reduction in graft rejection after transplantation, with the price being an increase of infectious complications, such as BK-related nephropathy. The targeting of new immunosuppressive pathways, such as interleukin-2-mammalian target of rapamycin inhibition, may have unexpected consequences for the immune response. Cell-depleting agents have long-lasting effects on cellular recovery and function, with the activation of latent viral infections and late viral and fungal infections. ⋯ The possible role of specific drugs in the occurrence of infections is discussed, with emphasis on the antibodies and fusion proteins. The unequivocal attribution of a given infection to a specific drug is often impossible, as the risk of infection is dependent on the entirety of immunosuppression and the epidemiological pressure ('net immunosuppression'). It is important to remain vigilant for unexpected infections, not only in the context of clinical studies with selected patients, but also in the routine follow-up of our transplant patients.