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Chatani B, Selvaggi G, Garcia J, Gonzalez IA. Describing universal Strongyloides serologic screening among pediatric intestinal and liver transplant recipients. Pediatr Transplant 2021; 25:e14039. [PMID: 34003552 DOI: 10.1111/petr.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Strongyloides spp hyperinfections are a worldwide phenomenon that proves fatal for solid organ transplant recipients. Screening protocols to guide prophylaxis management vary institution to institution from universal to epidemiology driven. Our institution initiated a universal screening protocol regardless of travel history and exposure to ensure no cases were missed. METHODS In this study, we describe the outcomes of three Strongyloides sero-positive children whom underwent intestinal or liver transplantation and the experience of universal screening at a tertiary care county hospital in South Florida. RESULTS Among the 66 intestine and liver pediatric transplant recipients who were screened for Strongyloides antibodies, only three were identified to be sero-positive via the screening mechanism. Two of three had significant epidemiology risk factors. None of the patients reviewed were found to have developed hyperinfection. However, reflecting on the experience represented by our series of pediatric patients, the risk of any complication related to Strongyloides status appears low. Even among this South Florida population whom come from or travel to endemic regions are in contact with sero-positive individuals, very few illustrate sero-positivity. CONCLUSION While institutions continue to analyze the cost-benefit of universal testing vs. universal prophylaxis vs. targeted screening, the decision must encompass the patient population, rolling cumulative incidence, and morbidity and mortality related to this disease.
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Affiliation(s)
- Brandon Chatani
- Pediatric Infectious Diseases, University of Miami Miller School of Medicine, Miami Transplant Institute/Jackson Health System, Miami, FL, USA
| | | | - Jennifer Garcia
- Pediatric Gastroenterology, University of Miami Miller School of Medicine, Miami Transplant Institute/Jackson Health System, Miami, FL, USA
| | - Ivan A Gonzalez
- Pediatric Infectious Diseases, University of Miami Miller School of Medicine, Miami Transplant Institute/Jackson Health System, Miami, FL, USA
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Ottino L, Buonfrate D, Paradies P, Bisoffi Z, Antonelli A, Rossolini GM, Gabrielli S, Bartoloni A, Zammarchi L. Autochthonous Human and Canine Strongyloides stercoralis Infection in Europe: Report of a Human Case in An Italian Teen and Systematic Review of the Literature. Pathogens 2020; 9:E439. [PMID: 32503315 PMCID: PMC7350350 DOI: 10.3390/pathogens9060439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61-70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode.
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Affiliation(s)
- Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, 70124 Bari, Italy;
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
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Ahmed SA, El-Moselhy A, El-Moammaly A, El-Shewy K. Strongyloides stercoralis in Patients on Corticosteroids Therapy Using Enzyme-Linked Immunosorbent Assay and Gelatin Particles Indirect Agglutination Tests: A Diagnostic Approach. Acta Parasitol 2019; 64:394-405. [PMID: 31069645 DOI: 10.2478/s11686-019-00060-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients on corticosteroids therapy (POCT) are more likely to flare up concealed Strongyloides infection and develop Strongyloides hyperinfection syndrome and/or dissemination. Such critical complications can lead to high mortality rates. Rapid detection methods are, therefore, necessary to detect Strongyloides infection in POCT with the advantage of being applicable in a developing country. METHODS Two hundred POCT have been enrolled in this study to determine the rate of infection with Strongyloides. Three different groups of POCT (Strongyloides infected, non-infected, infected with other parasites) were used to evaluate the antibodies detection capability of two serological techniques (enzyme-linked immunosorbent assay (ELISA) and gelatin particles indirect agglutination (GPIAT) against the results of the gold standard agar plate culture (APC). RESULTS With APC, the infection rate of Strongyloides stercoralis in POCT was 9.5% (19/200). POCT with Strongyloides infection displayed related risk factors (job, rural settlements, and soil contact) for infection combined with the subtropical nature of Ismailia Governorate. With regard to serology, ELISA detection results were poor compared to APC with sensitivity and specificity of 42.1% and 82.6%, respectively, and positive and negative predictive values of 72% and 30%. GPIAT appeared to be closely related to APC with sensitivity and specificity of 89.4% and 81.8%, respectively, and positive and negative predictive values of 80.9% and 96.7%. Statistical moderate correlation was detected between GPIAT and ELISA. CONCLUSION The GPIAT technique is more convenient, easier, cheaper and faster to rule out the infection of Strongyloides in POCT. It might be the test of choice for routine immunodiagnosis of human strongyloidiasis.
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Affiliation(s)
- Shahira A Ahmed
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Amany El-Moselhy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Amal El-Moammaly
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Khalid El-Shewy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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