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S. stercoralis documented from organ donor to recipients

Issue: May 2013

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The transmission of Strongyloides stercoralis to three of four organ recipients has been traced to a single donor, who was not tested for the disease before organ recovery, according to the CDC.

“This investigation underscores the importance of prompt communication between organ procurement organizations, transplant centers and public health authorities to prevent adverse events in recipients when transmission is suspected,” the investigators wrote in Morbidity and Mortality Weekly Report. “Additionally, it emphasizes the utility of store pretransplant samples for investigation of suspected transplant-transmitted infections and the need to consider the risk for Strongyloides infection in organ donors.”

In October, the United Network for Organ Sharing notified the CDC that the recipient of the donor’s left kidney and pancreas was diagnosed with strongyloidiasis. The CDC evaluated the pretransplant serum from the other three organ recipients and found that none of the recipients had detectable Strongyloides antibody before transplantation. The donor, however, had evidence of chronic infection.

The recipient of the donor’s right kidney also was diagnosed with strongyloidiasis, as was the heart’s recipient. The recipient of the liver died 4 days after transplant and had no evidence of Strongyloides infection at autopsy. All three of the infected recipients received treatment with ivermectin and albendazole (Albenza, Amedra Pharmaceuticals). Two of the recipients recovered. The heart recipient developed other infections and died 11 weeks after transplant.

“Results of testing [archived pretransplant serum] contributed to the determination that infection was donor derived and not reactivated chronic infection in the recipients,” the researchers wrote. “The growing evidence of transplant transmission of Strongyloides … might support development of recommendations for specific testing of donors and recipients from endemic regions to prevent severe strongyloidiasis in recipients.”