Abstract: PUB305
Seroprevalence and Management of Strongyloides stercoralis at a Large Tertiary Kidney Transplant Centre in London, United Kingdom
Session Information
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Srikantharajah, Mukunthan, Imperial College Healthcare NHS Trust, London, London, United Kingdom
- Rodzlan Akib, Mohd Radzi, Imperial College Healthcare NHS Trust, London, London, United Kingdom
- Sandhu, Eleanor Clotilde, Imperial College Healthcare NHS Trust, London, London, United Kingdom
- Arkell, Paul, Imperial College Healthcare NHS Trust, London, London, United Kingdom
Background
The soil transmitted helminth Stronglyoides stercoralis is endemic across the tropics and causes pauci/asymptomatic infection which persists for decades when no longer living in an endemic area. In individuals who receive corticosteroids and/or organ transplantation, rapid replication and dissemination of larvae can result in Strongyloides hyperinfection syndrome (SHS), a severe multi-system illness with high mortality. This study aimed to determine the seroprevalence of S. stercoralis at our centre and assess whether screening and pre-emptive treatment may be beneficial.
Methods
Kidney transplant candidates registered at our institution in West London between July-November 2021 were tested for S. stercoralis IgG/IgM (NovaLisa® ELISA, Eurofins Biomnis Laboratory). Results were obtained from 5 different haemodialysis units. Those with positive results were reviewed by the Infectious Diseases and/or Nephrology team.
Results
133 individuals were included. The mean age of the cohort was 52 years (range 19-79). 64% were male. 32% were Asian, 29% White, 24% Black, 13% Other, 2% Mixed. The most common underlying renal pathologies were Diabetes (30%), Unknown (21%), Glomerulonephritis (18%) and Hypertension (7%). 8/133 (6%) were found to be S. stercoralis seropositive. 7/8 of these individuals were born or had significant travel in the tropics but 1/8 had no identifiable epidemiological risk factors. Upon clinical review, 1/8 individuals had symptoms which were potentially attributable to strongyloidiasis, and 3/8 had eosinophilia. 7/8 were treated with ivermectin. 1/8 was concluded to be a false positive, most likely due to previous Taenia solium infection, and therefore was not treated. 5/8 individuals had previously undergone kidney transplantation and were at risk of SHS.
Conclusion
This study found a high S. stercoralis seroprevalence among renal transplant candidates. These individuals may be at risk of SHS upon receiving immunosupression. Targeted screening and pre-emptive treatment is likely to be beneficial.