Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study.

Background: Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection. Methodology/Principal findings: This was a retrospective, multicenter, case–control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5–965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05–18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2–7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001–1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46–2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83–35316.61). Conclusions/Significance: Severe S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment. Author summary: Strongyloides stercoralis is a soil-transmitted helminth found in tropical and subtropical regions worldwide. Although infections are usually mild or asymptomatic, they can be severe, with high mortality rates, in patients receiving immunosuppressive therapy, including organ transplant recipients. It is therefore relevant for countries endemic for infectious diseases such as strongyloidiasis to have a special focus on endemic diseases in organ transplant recipients. In this study, we describe the risk factors for and clinical findings of severe infection with S. stercoralis in kidney transplant recipients in Brazil. We retrospectively collected data from the medical charts of kidney transplant recipients diagnosed with severe strongyloidiasis, comparing them with those obtained for a control group of kidney transplant recipients with similar characteristics and no signs of strongyloidiasis. Gastrointestinal and respiratory symptoms were common, and 30-day crude mortality was 28.3% among the infected patients. Mortality was significantly higher when infection occurred within the first three months after transplantation, and we identified specific risk factors for S. stercoralis infection. Because there is little available information about severe strongyloidiasis in kidney transplant recipients, we believe that specific risk factors and clinical manifestations could identify patients at risk, who should receive prophylaxis or early treatment. [ABSTRACT FROM AUTHOR]