Transplant-related strongyloidiasis in solid organ transplant recipients in Saudi Arabia and the GCC countries

Abstract Background Strongyloidiasis is a devastating disease with a mortality rate exceeding 50% in immune-compromised patients. The disease usually results from reactivation of a latent infection in a transplant patient. Alternatively, donor-derived transmission of strongyloides may occur. Methods In this review we report a case of strongyloides hyperinfection syndrome in a liver transplant recipient to illustrate the severity of this infection. Following this we searched the PubMed for cases of transplant related strongyloidiasis in the Gulf Cooperation Council (GCC) countries. Demographic data, clinical presentation of recipients, and donors’ information were recorded. Methods of diagnosis, plan of treatment and clinical outcome were documented. Results A total of 12 transplant- related strongyloidiasis cases were found. 75% of the patients were from Saudi Arabia. Three cases from Kuwait shared common donors. All the donors were deceased and native to an endemic area for strongyloides. Five of the patients shared common donors raising the possibility of donor- derived infection. Neither the donors nor the recipients received screening test for Strongyloides. Concomitant bacteraemia and /or meningitis were seen in 50% (6 of 12 cases). Moreover, when documented, sepsis was detected in all the patients who died (3 cases). The mortality rate in this series was high (41.7%). Conclusion Since this is a preventable condition, early diagnosis and treatment is essential. Screening and treatment of potential transplant recipients and donors proved to be an effective preventive measure. There is a growing need for further studies and implementation of screening policies in the GCC countries to prevent this fatal infection.